MEDICARE: MR. CONRAD O OWINY

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	172A00000X	Driver	23154837	PA

General Provider Information

NPI Number	:	1760567788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CONRAD O OWINY

Provider Business Mailing Address
First Line	:	331 N OAK ST
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-6807
Country	:	US
Telephone Number	:	267-670-2119
Fax Number	:	267-670-2119

Provider Business Practice Location Address
First Line	:	331 N OAK ST
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-6807
Country	:	US
Telephone Number	:	267-670-2119
Fax Number	:	678-205-5985

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	05/19/2021

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Directions to “ MR. CONRAD O OWINY ” Practice Location

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