Provider Demographics
NPI:1639121650
Name:CONRAD, REGINA (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 DIDESSE DR STE D
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-6401
Mailing Address - Country:US
Mailing Address - Phone:225-769-6810
Mailing Address - Fax:225-768-7520
Practice Address - Street 1:7612 PICARDY AVE STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4353
Practice Address - Country:US
Practice Address - Phone:225-767-3800
Practice Address - Fax:225-766-8001
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200308208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271313600Medicaid
52076ZMedicare ID - Type Unspecified
FL271313600Medicaid