Provider Demographics
NPI:1467433318
Name:GONDOR, MAGDALEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGDALEN
Middle Name:
Last Name:GONDOR
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 1:601 5TH ST S
Mailing Address - Street 2:SUITE 708
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-4146
Mailing Address - Fax:727-767-4272
Practice Address - Street 1:601 5TH ST S
Practice Address - Street 2:SUITE 708
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4804
Practice Address - Country:US
Practice Address - Phone:727-767-8249
Practice Address - Fax:727-767-4272
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME757402080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254042800Medicaid
FL254042800Medicaid
FL43451ZMedicare ID - Type Unspecified