Provider Demographics
NPI:1467676510
Name:CONRAD, DOUGLAS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:CONRAD
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 1:4505 FAIRMEADOW LN
Mailing Address - Street 2:SUITE 208
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6449
Mailing Address - Country:US
Mailing Address - Phone:919-782-4954
Mailing Address - Fax:919-782-4849
Practice Address - Street 1:4505 FAIRMEADOW LN
Practice Address - Street 2:SUITE 208
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6449
Practice Address - Country:US
Practice Address - Phone:919-782-4954
Practice Address - Fax:919-782-4849
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202522084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8923893Medicaid
23893OtherBLUE CROSS BLUE SHIELD
NC203592Medicare ID - Type Unspecified
NC8923893Medicaid