Provider Demographics
NPI:1376506626
Name:CONROY, RIZA TADY (MD)
Entity Type:Individual
Prefix:
First Name:RIZA
Middle Name:TADY
Last Name:CONROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:RIZA
Other - Last Name:CONROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2614
Mailing Address - Fax:614-293-7001
Practice Address - Street 1:920 N HAMILTON RD
Practice Address - Street 2:STE. 300
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1757
Practice Address - Country:US
Practice Address - Phone:614-293-2614
Practice Address - Fax:614-293-7001
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2428840Medicaid
H87780Medicare UPIN
OHCO4110222Medicare PIN