Provider Demographics
NPI:1295829968
Name:CONARRO, PATRICK A (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:CONARRO
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 1:64 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1601
Mailing Address - Country:US
Mailing Address - Phone:706-864-6196
Mailing Address - Fax:
Practice Address - Street 1:64 MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1601
Practice Address - Country:US
Practice Address - Phone:706-864-6196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030737208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2383OtherGROUP IDENTIFIER
GA030737OtherLICENSE