Provider Demographics
NPI:1437180981
Name:CONRAD, DEBORAH A (PA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2638 PEARL STREET RD
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9634
Mailing Address - Country:US
Mailing Address - Phone:585-762-4823
Mailing Address - Fax:
Practice Address - Street 1:565 ABBTOTT RD.
Practice Address - Street 2:@ MERCY HOSPITAL OF BUFFALO
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220
Practice Address - Country:US
Practice Address - Phone:716-828-2434
Practice Address - Fax:716-828-3417
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009356-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02670042Medicaid
NY02670042Medicaid
NYQ34961Medicare UPIN