Healthcare Provider Details

I. General information

NPI: 1902258197
Provider Name (Legal Business Name): GERALD CONRAD PA-C, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 TRANSPORTATION DR
SHEFFIELD VILLAGE OH
44054-2850
US

IV. Provider business mailing address

5001 TRANSPORTATION DR
SHEFFIELD VILLAGE OH
44054-2850
US

V. Phone/Fax

Practice location:
  • Phone: 440-329-2800
  • Fax:
Mailing address:
  • Phone: 440-329-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.009842RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.009842RX
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT005470
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: