MEDICARE: PETER CONDRO JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	0101037802	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144228503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER CONDRO JR. M.D.

Provider Business Mailing Address
First Line	:	671 HIOAKS RD
Second Line	:	SUITE B
City	:	RICHMOND
State	:	VA
Zip	:	23225
Country	:	US
Telephone Number	:	804-272-5814
Fax Number	:	804-560-0232

Provider Business Practice Location Address
First Line	:	671 HIOAKS RD
Second Line	:	SUITE B
City	:	RICHMOND
State	:	VA
Zip	:	23225
Country	:	US
Telephone Number	:	804-272-5814
Fax Number	:	804-560-0232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	11/11/2016

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