DR. EMILY DENISE FONDAHN (NPI# 1609038074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609038074 |
| Entity Type | Individual |
| Full Name | DR. EMILY DENISE FONDAHN |
| Credential | MD |
| Practice Address |
4960 Childrens Pl Saint Louis MO 63110-1000 |
| Mailing Address |
660 S Euclid Ave C B 8121 Saint Louis MO 63110-1010 |
| Practice Telephone | 3149968103 |
| Practice Fax Number | 3143625969 |
| Mailing Telephone | 3143625060 |
| Mailing Fax Number | 3143625969 |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2018-01-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 2011012592 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | ENROLLED | 05 | |
| MO | 1609038074 | 05 |
| Street Address |
4960 CHILDRENS PL |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63110-1000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790701910 | Martin L Mayse | Internal Medicine | 4960 Childrens Pl, Saint Louis, MO 63110-1000 | 2006-07-14 |
| 1356602585 | Brian M. Rosman | Student in an Organized Health Care Education/Training Program | 4960 Childrens Pl, Division of Urologic Surgery, Box 4282, Saint Louis, MO 63110-1000 | 2012-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1881210466 | Michelle Amanda Freilich | Internal Medicine | Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-06-19 |
| 1245856046 | Jeevin Shahi | Radiology | 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 | 2020-06-18 |
| 1497371314 | Wilson Eduardo Rodriguez | Student in an Organized Health Care Education/Training Program | 1008 S. Spring, St Louis, MO 63110 | 2020-06-17 |
| 1578184065 | Kathryn Kay Lindsay | Registered Nurse | Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 | 2020-05-06 |
| 1881232700 | Ashley Diane Pace | Nurse Practitioner | 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 | 2019-12-11 |
| 1619520418 | Krithika Damodar Shenoy | Pathology | 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 | 2019-07-20 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1760978688 | Ihab Hassanieh | Student in an Organized Health Care Education/Training Program | 33660 Vista Ave, St. Louis, MO 63110 | 2018-07-03 |
| 1336634500 | Martin K Mwangi | Pediatrics | 1 Childrens Place, 3s34, St. Louis, M, MO 63110 | 2018-06-28 |
| Find all providers in zip 63110 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790205854 | Zachary Avital Goodman | General Practice | 6642 Clayton Rd # 278, Saint Louis, MO 63117-1602 | 2017-06-20 |
| 1174926224 | Anita Dewan | General Practice | 9917 Grandview Forest Ct, Saint Louis, MO 63127-0046 | 2014-10-03 |
| 1356755201 | Jessica Ellie Ma | General Practice | 216 S Kingshighway Blvd Fl 6, 6th Floor, Saint Louis, MO 63110-1026 | 2014-06-19 |
| 1235550385 | Doctor's On The Way, Inc | General Practice | 712 N 2nd St, Ste 310, Saint Louis, MO 63102-2550 | 2013-12-16 |
| 1518398916 | John Allen Cooper | General Practice | 40 N Kingshighway Blvd Apt 13f, Saint Louis, MO 63108-1343 | 2013-12-10 |
| 1417382821 | Hyung T Kim | General Practice | 11 Crestwood Dr, Saint Louis, MO 63105-3032 | 2013-09-05 |
| 1356617443 | Kirsten Frances Dunn | General Practice | 1040 N Mason Rd Ste 103, Ste 103, Saint Louis, MO 63141-6361 | 2012-03-22 |
| 1902199623 | Care Plus Medical Group LLC | General Practice | 10650 Gateway Blvd, Saint Louis, MO 63132-1802 | 2011-05-27 |
| 1437474202 | Debra Lynne Moss | General Practice | 12929 Ballantine Ct, Saint Louis, MO 63146-3701 | 2010-04-05 |
| 1558538850 | Patrice Lynn Wakefield | General Practice | 514 Donne Ave, Saint Louis, MO 63130-3918 | 2008-05-15 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63110 |
Please comment or provide details below to improve the information on DR. EMILY DENISE FONDAHN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.