Basic Information
| Provider Information | |||||||||
| NPI: | 1184103723 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PONDY | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | CLARYSSE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6920 POINTE INVERNESS WAY STE 200 | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468047934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604793513 | ||||||||
| FaxNumber: | 2604793520 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MENTONE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465399723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5743537561 | ||||||||
| FaxNumber: | 2604792908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2018 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 01086633A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.