Provider Demographics
NPI:1801221858
Name:TONDA, MEDIE GEZI (MED)
Entity Type:Individual
Prefix:
First Name:MEDIE
Middle Name:GEZI
Last Name:TONDA
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 POULIOT PL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-4560
Mailing Address - Country:US
Mailing Address - Phone:781-244-2625
Mailing Address - Fax:
Practice Address - Street 1:1901 POULIOT PL
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-4560
Practice Address - Country:US
Practice Address - Phone:781-244-2625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)