Provider Demographics
NPI:1871686592
Name:CONERMANN, TILL (MD)
Entity Type:Individual
Prefix:
First Name:TILL
Middle Name:
Last Name:CONERMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2257
Mailing Address - Country:US
Mailing Address - Phone:412-315-3800
Mailing Address - Fax:412-315-3801
Practice Address - Street 1:5124 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2257
Practice Address - Country:US
Practice Address - Phone:412-315-3800
Practice Address - Fax:412-315-3801
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426489207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009810Medicaid
OH2767420Medicaid
PA101742089Medicaid
OH2767420Medicaid