Healthcare Provider Details

I. General information

NPI: 1083739700
Provider Name (Legal Business Name): CHAD EDWARD CONNOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

4881 SUGAR MAPLE DR
WRIGHT PATTERSON AFB OH
45433-5529
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-7269
  • Fax:
Mailing address:
  • Phone: 937-257-1617
  • Fax: 937-257-1819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35092796
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: