Healthcare Provider Details

I. General information

NPI: 1023189958
Provider Name (Legal Business Name): KRISTIN A CONLEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 BANK CT
FREDERICK MD
21703-8483
US

IV. Provider business mailing address

PO BOX 37086
BALTIMORE MD
21297-3086
US

V. Phone/Fax

Practice location:
  • Phone: 240-566-7830
  • Fax:
Mailing address:
  • Phone: 240-439-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberH82576
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberH0082576
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH0082576
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: