Provider Demographics
NPI:1003891052
Name:CONROY, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:CONROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2347
Mailing Address - Country:US
Mailing Address - Phone:937-433-7536
Mailing Address - Fax:937-433-9612
Practice Address - Street 1:7450 HOSPITAL DRIVE
Practice Address - Street 2:STE 370
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9624
Practice Address - Country:US
Practice Address - Phone:614-760-1401
Practice Address - Fax:614-652-3048
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33473207N00000X
OH35091436207ZD0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00200386OtherRAILROAD MEDICARE
AZ86080015085259B051OtherTRIWEST
OH000000581571OtherANTHEM BLUE CROSS/BLUE SHIELD
OHP00713302OtherRAILROAD MEDICARE
OHC04237701Medicare PIN
OH000000581571OtherANTHEM BLUE CROSS/BLUE SHIELD
AZZ100789Medicare PIN