Provider Demographics
NPI:1447416128
Name:RONDON VIDAL, MICHEL JUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:JUAN
Last Name:RONDON VIDAL
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:330 BORTHWICK AVE
Mailing Address - Street 2:STE 111
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4174
Mailing Address - Country:US
Mailing Address - Phone:603-294-4424
Mailing Address - Fax:603-319-1603
Practice Address - Street 1:330 BORTHWICK AVE
Practice Address - Street 2:STE 111
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4174
Practice Address - Country:US
Practice Address - Phone:603-294-4424
Practice Address - Fax:603-319-1603
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2022-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 1109232084P0805X
CAC561432084P0805X, 2084P0800X
NH140952084P0805X
MEMD189512084P0805X
PAMD4490532084P0800X
NY268558-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry