Provider Demographics
NPI:1326194382
Name:CONRAD K. KING JR., M.D., P.A.
Entity Type:Organization
Organization Name:CONRAD K. KING JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LEAD PRACTIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:KING
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:302-838-5600
Mailing Address - Street 1:1400 PEOPLES PLZ
Mailing Address - Street 2:SUITE 233
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5707
Mailing Address - Country:US
Mailing Address - Phone:302-838-5600
Mailing Address - Fax:302-838-5601
Practice Address - Street 1:1400 PEOPLES PLZ
Practice Address - Street 2:SUITE 233
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5707
Practice Address - Country:US
Practice Address - Phone:302-838-5600
Practice Address - Fax:302-838-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100045412081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE122143Medicare ID - Type Unspecified
DED75923Medicare UPIN