Provider Demographics
NPI:1225025067
Name:LONDEREE, GWYN RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:GWYN
Middle Name:RENE
Last Name:LONDEREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 FIRTH AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2913
Mailing Address - Country:US
Mailing Address - Phone:614-442-0100
Mailing Address - Fax:614-442-7753
Practice Address - Street 1:4900 GETTYSBURG RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2520
Practice Address - Country:US
Practice Address - Phone:614-442-0100
Practice Address - Fax:614-442-7753
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-9165L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000197955OtherANTHEM BC/BS
OHG73016Medicare UPIN
OHLO0838242Medicare ID - Type Unspecified