Provider Demographics
NPI:1578677472
Name:KONRAD, EDYTA M (MD)
Entity Type:Individual
Prefix:
First Name:EDYTA
Middle Name:M
Last Name:KONRAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:408 WINCH ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3885
Mailing Address - Country:US
Mailing Address - Phone:508-460-6002
Mailing Address - Fax:508-460-6028
Practice Address - Street 1:640 BOLTON ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3999
Practice Address - Country:US
Practice Address - Phone:508-460-6002
Practice Address - Fax:508-460-6028
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA157585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine