Provider Demographics
NPI:1215986245
Name:KONDAN, RICHARD A (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:KONDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:599 W STATE ST
Mailing Address - Street 2:STE 203
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901
Mailing Address - Country:US
Mailing Address - Phone:215-348-9711
Mailing Address - Fax:215-348-9784
Practice Address - Street 1:599 W STATE ST
Practice Address - Street 2:STE 203
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901
Practice Address - Country:US
Practice Address - Phone:215-348-9711
Practice Address - Fax:215-348-9784
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007466L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014792030005Medicaid
PA757336OtherBCBS
PA07000290010OtherKEYSTONE
PA1296316008OtherCIGNA
PA1296316008OtherCIGNA
PA07000290010OtherKEYSTONE