Provider Demographics
NPI:1073795837
Name:CONDON, IAN M (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:M
Last Name:CONDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:757-399-7451
Mailing Address - Fax:757-399-1158
Practice Address - Street 1:3200 TYRE NECK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3329
Practice Address - Country:US
Practice Address - Phone:757-399-7451
Practice Address - Fax:757-399-1158
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101249073207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology