Provider Demographics
NPI:1215163571
Name:CONDORODIS, CHRISTOPHER JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:CONDORODIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11135 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2338
Mailing Address - Country:US
Mailing Address - Phone:513-793-2220
Mailing Address - Fax:513-793-5933
Practice Address - Street 1:11135 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2338
Practice Address - Country:US
Practice Address - Phone:513-793-2220
Practice Address - Fax:513-793-5933
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 093478207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCO4270931OtherMEDICARE PTAN
OH0132261OtherMEDICAID LEGACY PROVIDER NUMBER