MEDICARE: JOHN CRAIG KONRAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1689518680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CRAIG KONRAD

Provider Business Mailing Address
First Line	:	135 SCHOOL ST UNIT 1
Second Line	:
City	:	ROXBURY
State	:	MA
Zip	:	02119-3110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 FOGG RD
Second Line	:
City	:	SOUTH WEYMOUTH
State	:	MA
Zip	:	02190-2455
Country	:	US
Telephone Number	:	781-624-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2026
Last Update Date	:	04/18/2026

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