Provider Demographics
NPI:1699076869
Name:DONALD J. CONLON, M.D PROFESSIONAL CORP.
Entity type:Organization
Organization Name:DONALD J. CONLON, M.D PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-370-7200
Mailing Address - Street 1:340 DARDANELLI LN
Mailing Address - Street 2:SUITE 13
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1418
Mailing Address - Country:US
Mailing Address - Phone:408-370-7200
Mailing Address - Fax:408-370-0935
Practice Address - Street 1:340 DARDANELLI LN
Practice Address - Street 2:SUITE 13
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1418
Practice Address - Country:US
Practice Address - Phone:408-370-7200
Practice Address - Fax:408-370-0935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC186470207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA31302Medicare UPIN