Provider Demographics
NPI:1346536489
Name:CONDINO, JASON J (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:J
Last Name:CONDINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 TOMCAT BLVD
Mailing Address - Street 2:NAS OCEANA BRANCH HEALTH CLINIC
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23460-2188
Mailing Address - Country:US
Mailing Address - Phone:757-953-3779
Mailing Address - Fax:
Practice Address - Street 1:1550 TOMCAT BLVD
Practice Address - Street 2:NAS OCEANA BRANCH HEALTH CLINIC
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23460-2188
Practice Address - Country:US
Practice Address - Phone:577-953-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252585171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider