Healthcare Provider Details

I. General information

NPI: 1932267374
Provider Name (Legal Business Name): REBECCA S CONRAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 COTTMAN AVE
PHILADELPHIA PA
19149-1230
US

IV. Provider business mailing address

147 PELHAM RD
PHILADELPHIA PA
19119-2661
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-0639
  • Fax: 215-725-4877
Mailing address:
  • Phone: 215-685-0639
  • Fax: 215-725-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD015478E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: