Provider Demographics
NPI:1619900073
Name:CHAO, CONRAD RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:RUSSELL
Last Name:CHAO
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:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY HSC
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO MSC 10 5580
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-6372
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY HSC
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO MSC 10 5580
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-6372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50136207V00000X, 207VM0101X
NMMD2016-0033207VM0101X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G501360Medicaid
CAAY586ZOtherMEDICARE PTAN
CAAY586ZOtherMEDICARE PTAN