1528062858 NPI number — DR. ROBERT WADE CONROY D.O.

Table of content: DR. ROBERT WADE CONROY D.O. (NPI 1528062858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528062858 NPI number — DR. ROBERT WADE CONROY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONROY
Provider First Name:
ROBERT
Provider Middle Name:
WADE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1528062858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 FAUNCE CORNER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DARTMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02747-1242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-996-3991
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 FAUNCE CORNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARTMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02747-1242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-996-3991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2005

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: 2084S0012X , with the licence number:  79648 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0003724 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 751021 . This is a "TUFTS/SECURE HORIZON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 024037 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3124924 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9046461001 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J14566 . This is a "HMO BLUE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043402250 . This is a "TAX IDENTIFICATION" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M16840 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 11965 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 05-00067 . This is a "UNITED HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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