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General NPI Number Information
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NPI Number | 1790711547
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Entity Type | Individual
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Provider Name | CONRADA C. OLA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 04/02/2009
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Provider Practice Location Address
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Address Line | 1315 WINDRIM AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19141-2710
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Country | US
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Telephone | 215-455-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 3101 BOARDWALK TOWER 2 APARTMENT 2702
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City | ATLANTIC CITY
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State | NJ
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Zip | 08401-5162
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Country | US
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Telephone | 609-317-4170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD037757L
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License Number State | PA
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