Provider Demographics
NPI:1831139765
Name:CONRAD, KATRINA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LYNN
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 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5221 PARAMOUNT PKWY STE 220
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-5490
Practice Address - Country:US
Practice Address - Phone:984-215-6050
Practice Address - Fax:984-215-4053
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD204855207VB0002X
NC200201232207V00000X
NH19792207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1328YOtherBCBS
NC891328YMedicaid
NC2331276Medicare ID - Type Unspecified
NC891328YMedicaid