Healthcare Provider Details

I. General information

NPI: 1225424583
Provider Name (Legal Business Name): RACHEL CHRISTINE CONRAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ANNA MARSH LN
DUMMERSTON VT
05301-3292
US

IV. Provider business mailing address

22 ANNA MARSH LN
DUMMERSTON VT
05301-3292
US

V. Phone/Fax

Practice location:
  • Phone: 802-258-3737
  • Fax:
Mailing address:
  • Phone: 802-258-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number275043
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number275043
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier042.0018109-COMP
Identifier TypeOTHER
Identifier StateVT
Identifier IssuerVERMONT MEDICAL LICENSE
# 2
Identifier275043
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMASSACHUSETTS MEDICAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: