MEDICARE: CONRADO A VALDES 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	207L00000X	Anesthesiology Physician	MD037357L	PA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730180951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONRADO A VALDES M.D.

Provider Business Mailing Address
First Line	:	763 JOHNSONBURG RD
Second Line	:	ERPG ANESTHESIA SERVICES
City	:	ST MARYS
State	:	PA
Zip	:	15857-3417
Country	:	US
Telephone Number	:	814-788-8189
Fax Number	:	814-788-8387

Provider Business Practice Location Address
First Line	:	763 JOHNSONBURG RD
Second Line	:	ERPG ANESTHESIA SERVICES
City	:	ST MARYS
State	:	PA
Zip	:	15857-3417
Country	:	US
Telephone Number	:	814-788-8189
Fax Number	:	814-788-8387

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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