1346235298 NPI number — MARGARET S CONRADI ED D

Table of content: MARGARET S CONRADI ED D (NPI 1346235298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346235298 NPI number — MARGARET S CONRADI ED D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONRADI
Provider First Name:
MARGARET
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ED D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEWELL
Provider Other First Name:
MARGARET
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1346235298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
727 ALPINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45150-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-831-0827
Provider Business Mailing Address Fax Number:
513-831-1294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8595 BEECHMONT AVE
Provider Second Line Business Practice Location Address:
#303
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45255-4783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-474-3605
Provider Business Practice Location Address Fax Number:
513-831-1294
Provider Enumeration Date:
09/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  3174 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000002625 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0509284 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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