Provider Demographics
NPI:1922140284
Name:LOEHLEIN, CONRAD P (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CONRAD
Middle Name:P
Last Name:LOEHLEIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14A TIBBETTS TOWN WAY
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1610
Mailing Address - Country:US
Mailing Address - Phone:781-338-1036
Mailing Address - Fax:
Practice Address - Street 1:61 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3364
Practice Address - Country:US
Practice Address - Phone:781-279-2797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1396363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical