Provider Demographics
NPI:1831490135
Name:DA CONCEICAO, LUIS R P (PAS)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:R P
Last Name:DA CONCEICAO
Suffix:
Gender:M
Credentials:PAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6461 230TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2713
Mailing Address - Country:US
Mailing Address - Phone:516-901-5446
Mailing Address - Fax:
Practice Address - Street 1:20010 CENTURY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1118
Practice Address - Country:US
Practice Address - Phone:516-901-5446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPA78442363A00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant