Provider Demographics
NPI:1790893972
Name:KOTRADY, KONRAD P (MD)
Entity Type:Individual
Prefix:DR
First Name:KONRAD
Middle Name:P
Last Name:KOTRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CONRAD
Other - Middle Name:P
Other - Last Name:KOTRADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:972 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-3487
Mailing Address - Country:US
Mailing Address - Phone:860-827-0745
Mailing Address - Fax:860-827-0824
Practice Address - Street 1:972 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3487
Practice Address - Country:US
Practice Address - Phone:860-827-0745
Practice Address - Fax:860-827-0824
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC63401Medicare UPIN