Provider Demographics
NPI:1700440401
Name:PAMELA ONDERKO DPM LLC
Entity Type:Organization
Organization Name:PAMELA ONDERKO DPM LLC
Other - Org Name:RIVERSIDE FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ONDERKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:478-200-7143
Mailing Address - Street 1:5223 RIVERSIDE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-0889
Mailing Address - Country:US
Mailing Address - Phone:478-200-7143
Mailing Address - Fax:478-254-9704
Practice Address - Street 1:5223 RIVERSIDE DR STE 104
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-0889
Practice Address - Country:US
Practice Address - Phone:478-318-3128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-28
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty