Provider Demographics
NPI:1992834873
Name:CONDURACHE, CARMEN TANIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:TANIA
Last Name:CONDURACHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4803 OLYMPIA PARK PLZ STE 1100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-3068
Mailing Address - Country:US
Mailing Address - Phone:502-559-9295
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:231 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-629-6000
Practice Address - Fax:502-629-4617
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41028208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200900580Medicaid
KY7100035480Medicaid
KY7100035480Medicaid