Provider Demographics
NPI:1073615829
Name:CONN, LOIS MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:MARIE
Last Name:CONN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LOIS
Other - Middle Name:CONN
Other - Last Name:WEINSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:16 PEBBLE LN
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3366
Mailing Address - Country:US
Mailing Address - Phone:410-561-1160
Mailing Address - Fax:410-561-5598
Practice Address - Street 1:16 PEBBLE LN
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3366
Practice Address - Country:US
Practice Address - Phone:410-561-1160
Practice Address - Fax:410-561-5598
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD239402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2415LMOtherBLUE CROSS & SHIELD
MDC57515Medicare ID - Type Unspecified
MD2415LMOtherBLUE CROSS & SHIELD