Provider Demographics
NPI:1811989908
Name:CONARTY, PAUL F (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:CONARTY
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 1:3702 NEW VISION DR
Mailing Address - Street 2:BLDG B
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1703
Mailing Address - Country:US
Mailing Address - Phone:260-266-8210
Mailing Address - Fax:
Practice Address - Street 1:11141 PARKVIEW PLAZA DR
Practice Address - Street 2:SUITE 310
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1701
Practice Address - Country:US
Practice Address - Phone:260-489-8898
Practice Address - Fax:260-373-4695
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052710A208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2206599Medicaid
IN000000614752OtherANTHEM
IN200267890Medicaid
IN200267890AMedicaid
IN280000983OtherRR MEDICARE
IN000000595624OtherANTHEM
INP00664357OtherMEDICARE RAILROAD
IN200267890AMedicaid
OH2206599Medicaid
IN000000614752OtherANTHEM