Healthcare Provider Details

I. General information

NPI: 1922093905
Provider Name (Legal Business Name): CONRAD HENRY DAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W MAIN ST
RADFORD VA
24141-1588
US

IV. Provider business mailing address

PO BOX 8994
ROANOKE VA
24014-0776
US

V. Phone/Fax

Practice location:
  • Phone: 540-838-8000
  • Fax: 540-982-1116
Mailing address:
  • Phone: 540-982-5603
  • Fax: 540-982-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101023841
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: