Provider Demographics
NPI:1154337087
Name:CONRAD, ANNE E (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:E
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:241 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2924
Mailing Address - Country:US
Mailing Address - Phone:631-367-5300
Mailing Address - Fax:631-351-4561
Practice Address - Street 1:241 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2924
Practice Address - Country:US
Practice Address - Phone:631-367-5300
Practice Address - Fax:631-351-4561
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216658-12080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2650564OtherOXFORD
NY501X41OtherBLUE CROSS/ BLUE SHIELD
NY01886460Medicaid
NY2697759OtherGHI
NY4C4524OtherHEALTHNET
NYP2650564OtherOXFORD
NY2697759OtherGHI