Provider Demographics
NPI:1689873127
Name:CONDE, AUTUMN DAWN (DO)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:DAWN
Last Name:CONDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 COMPOSITE DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1475
Mailing Address - Country:US
Mailing Address - Phone:937-293-8419
Mailing Address - Fax:937-293-1545
Practice Address - Street 1:1900 COMPOSITE DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1475
Practice Address - Country:US
Practice Address - Phone:937-293-8419
Practice Address - Fax:937-293-1545
Is Sole Proprietor?:No
Enumeration Date:2007-07-14
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD152457207Q00000X
OH34.009523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine