Provider Demographics
NPI:1528370665
Name:CONRAD, MAIRE ABRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:MAIRE
Middle Name:ABRAHAM
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAIRE
Other - Middle Name:MADDEN
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:34TH ST. & CIVIC CENTER BLVD
Mailing Address - Street 2:THE CHILDREN'S HOSPITAL OF PHILADELPHIA, ROOM 7NW41
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4399
Mailing Address - Country:US
Mailing Address - Phone:215-590-2437
Mailing Address - Fax:215-590-2768
Practice Address - Street 1:34TH ST. & CIVIC CENTER BLVD
Practice Address - Street 2:THE CHILDREN'S HOSPITAL OF PHILADELPHIA, ROOM 9NW55
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4399
Practice Address - Country:US
Practice Address - Phone:215-590-3630
Practice Address - Fax:215-590-3606
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT197770208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics