Provider Demographics
NPI:1700879764
Name:POND, ALLISON L (DO)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:L
Last Name:POND
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 1:19900 STATE ROUTE 739
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9256
Mailing Address - Country:US
Mailing Address - Phone:379-642-0298
Mailing Address - Fax:937-645-8329
Practice Address - Street 1:19900 STATE ROUTE 739
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-4304
Practice Address - Country:US
Practice Address - Phone:937-642-0298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2513720Medicaid
OH2513720Medicaid
OHPO4142721Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE