Provider Demographics
NPI:1922272103
Name:CONROY, GRETCHEN LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:LYNN
Last Name:CONROY
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 1:500 E 85TH ST
Mailing Address - Street 2:#21A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7405
Mailing Address - Country:US
Mailing Address - Phone:312-835-0560
Mailing Address - Fax:
Practice Address - Street 1:24401 CALLE DE LA LOUISA STE 200
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3624
Practice Address - Country:US
Practice Address - Phone:499-452-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361135822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology