Provider Demographics
NPI:1245210459
Name:CONDOLUCI, DAVID V (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:V
Last Name:CONDOLUCI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 HADDONFIELD BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:709 HADDONFIELD BERLIN RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3715
Practice Address - Country:US
Practice Address - Phone:856-566-3190
Practice Address - Fax:856-783-2193
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB42223207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ440000826OtherRAILROAD MEDICARE
NJ748404Medicaid
NJ748404Medicaid
NJ070878CDJMedicare PIN