Provider Demographics
NPI:1659309383
Name:BAKONDY, ROBERT S (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:BAKONDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 182255
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-2255
Mailing Address - Country:US
Mailing Address - Phone:614-430-5724
Mailing Address - Fax:
Practice Address - Street 1:7525 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5623
Practice Address - Country:US
Practice Address - Phone:330-758-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002028207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000379656OtherANTHEM
OH0360050Medicaid
P00266378OtherMEDICARE RAILROAD
OH0360050Medicaid
A73888Medicare UPIN