Provider Demographics
NPI:1295803567
Name:GONDUSKY, JOSEPH S
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:GONDUSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5716 CLEVELAND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1784
Mailing Address - Country:US
Mailing Address - Phone:757-490-4802
Mailing Address - Fax:
Practice Address - Street 1:5716 CLEVELAND ST STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1784
Practice Address - Country:US
Practice Address - Phone:757-490-4802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058188A207X00000X
CAA119281207X00000X
VA0101255125207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty