Provider Demographics
NPI:1306838867
Name:MEDINA, RHONDA J (MD)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:J
Last Name:MEDINA
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 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:1220 E ELM ST STE 101
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2803
Practice Address - Country:US
Practice Address - Phone:419-998-8245
Practice Address - Fax:419-998-8247
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.077824207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2180143Medicaid
OHP00137583OtherRR MEDICARE
OH322213OtherANTHEM
OHH15515Medicare UPIN
OHP00137583OtherRR MEDICARE
OH4019724Medicare PIN
OH4019726Medicare PIN
OH4019723Medicare PIN
OH4019725Medicare PIN