Provider Demographics
NPI:1942243308
Name:CONCEPCION, NOEL L (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:L
Last Name:CONCEPCION
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:PO BOX 576649
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-6649
Mailing Address - Country:US
Mailing Address - Phone:209-573-3333
Mailing Address - Fax:209-844-0334
Practice Address - Street 1:6466 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-3134
Practice Address - Country:US
Practice Address - Phone:209-277-6792
Practice Address - Fax:209-844-0334
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG567042086S0129X, 208G00000X
GUM-14882086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACD069AOtherMEDICARE GROUP PTAN
CAZZZ76734ZMedicaid
CACD069AOtherMEDICARE GROUP PTAN
D26868Medicare UPIN