Provider Demographics
NPI:1982609020
Name:ONDREKO, DARLA K (DO)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:K
Last Name:ONDREKO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DARLA
Other - Middle Name:K
Other - Last Name:RADDISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:210 SEVENTH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750
Practice Address - Country:US
Practice Address - Phone:740-374-2999
Practice Address - Fax:740-374-3121
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2333862Medicaid
G80008Medicare UPIN
OH2333862Medicaid