Provider Demographics
NPI:1962665018
Name:CONN FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:CONN FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAIN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CONN
Authorized Official - Suffix:
Authorized Official - Credentials:MD/PHD
Authorized Official - Phone:724-628-9350
Mailing Address - Street 1:2616 MEMORIAL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-1418
Mailing Address - Country:US
Mailing Address - Phone:724-628-9350
Mailing Address - Fax:724-628-9353
Practice Address - Street 1:2616 MEMORIAL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-1418
Practice Address - Country:US
Practice Address - Phone:724-628-9350
Practice Address - Fax:724-628-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427026207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty