Provider Demographics
NPI:1215008636
Name:FRONDORF, GREGORY T (RN, CRNA)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:T
Last Name:FRONDORF
Suffix:
Gender:M
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NORTHLAND BOULEVARD
Mailing Address - Street 2:OUTPATIENT ANESTHESIA SPECIALIST
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246
Mailing Address - Country:US
Mailing Address - Phone:513-204-5696
Mailing Address - Fax:877-284-4283
Practice Address - Street 1:3000 HOSPITAL DRIVE
Practice Address - Street 2:MERCY CLERMONT HOSPITAL
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103
Practice Address - Country:US
Practice Address - Phone:513-732-8255
Practice Address - Fax:513-732-8713
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH262262367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2764147Medicaid
OH2764147Medicaid