Healthcare Provider Details

I. General information

NPI: 1013505163
Provider Name (Legal Business Name): BRIAN CONRAD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N FAYETTEVILLE ST
ASHEBORO NC
27203-4728
US

IV. Provider business mailing address

3031 LAWSON CT
RANDLEMAN NC
27317-9717
US

V. Phone/Fax

Practice location:
  • Phone: 336-460-0794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: