Provider Demographics
NPI:1376648337
Name:KONDRUP, JAMES DANA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DANA
Last Name:KONDRUP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11393
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4004
Mailing Address - Country:US
Mailing Address - Phone:941-207-5330
Mailing Address - Fax:941-207-5346
Practice Address - Street 1:8431 POINTE LOOP DR FL 2
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-2232
Practice Address - Country:US
Practice Address - Phone:941-207-5330
Practice Address - Fax:941-207-5346
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY174463207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB0321Medicare ID - Type Unspecified
NYB83063Medicare UPIN