Provider Demographics
NPI:1265458731
Name:MONDA, CLIFFORD A (DO)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:A
Last Name:MONDA
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:PO BOX 50087
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-0019
Mailing Address - Country:US
Mailing Address - Phone:864-330-1666
Mailing Address - Fax:864-330-1870
Practice Address - Street 1:1530 PARKWAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4027
Practice Address - Country:US
Practice Address - Phone:864-330-1666
Practice Address - Fax:864-330-1870
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC720208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT00406Medicaid
SC1124Medicare PIN
SC9035Medicare PIN
SCH82261Medicare UPIN
SC6053Medicare PIN
P00669022Medicare PIN