Provider Demographics
NPI:1821044645
Name:CONRAD, CARL G (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:G
Last Name:CONRAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 EIGHTH STREE NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646
Mailing Address - Country:US
Mailing Address - Phone:330-832-8761
Mailing Address - Fax:330-837-4756
Practice Address - Street 1:875 8TH ST NE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8503
Practice Address - Country:US
Practice Address - Phone:330-832-8761
Practice Address - Fax:330-834-4756
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085474207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000353942OtherANTHEM
P00201891OtherMEDICARE RAILROAD
OH2549639Medicaid
OH2549639Medicaid
E75157Medicare UPIN