Provider Demographics
NPI:1144216839
Name:FONDRIEST, JOSEPH E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:FONDRIEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 CHERRY VALLEY RD
Mailing Address - Street 2:P O BOX 948
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1323
Mailing Address - Country:US
Mailing Address - Phone:740-522-3774
Mailing Address - Fax:740-522-2221
Practice Address - Street 1:2112 CHERRY VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1323
Practice Address - Country:US
Practice Address - Phone:740-522-3774
Practice Address - Fax:740-522-2221
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH663562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0978438Medicaid
OH0978438Medicaid
OHFO0761941Medicare ID - Type Unspecified