MEDICARE: DR. REGINA CONRAD MD

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	208000000X	Pediatrics Physician	MD200308	LA

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	:	1639121650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGINA CONRAD MD

Provider Business Mailing Address
First Line	:	5319 DIDESSE DR STE D
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-6401
Country	:	US
Telephone Number	:	225-769-6810
Fax Number	:	225-768-7520

Provider Business Practice Location Address
First Line	:	7612 PICARDY AVE STE C
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4353
Country	:	US
Telephone Number	:	225-767-3800
Fax Number	:	225-766-8001

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	05/02/2009

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