Provider Demographics
NPI:1689705618
Name:KONDASH, DENNIS JAMES (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JAMES
Last Name:KONDASH
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 1:211 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1138
Mailing Address - Country:US
Mailing Address - Phone:610-377-7174
Mailing Address - Fax:610-377-4785
Practice Address - Street 1:211 N 12TH ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1138
Practice Address - Country:US
Practice Address - Phone:610-377-7174
Practice Address - Fax:610-377-4785
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004813L207QA0505X, 207QG0300X
DEC2-0007569207QA0505X, 207QG0300X, 207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28978Medicare UPIN
DEC28978Medicare UPIN
PA174977Medicare ID - Type Unspecified