Provider Demographics
NPI:1184684623
Name:CONRAD, TABITHA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:L
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:640 KOLTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3570
Mailing Address - Country:US
Mailing Address - Phone:724-357-7333
Mailing Address - Fax:724-357-7279
Practice Address - Street 1:120 IRMC DR STE 160
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3675
Practice Address - Country:US
Practice Address - Phone:724-465-2676
Practice Address - Fax:724-349-1830
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2022-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA003026L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant