1134136492 NPI number — DR. BRENDAN CONROY M.D.

Table of content: DR. BRENDAN CONROY M.D. (NPI 1134136492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134136492 NPI number — DR. BRENDAN CONROY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONROY
Provider First Name:
BRENDAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134136492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 S SHERWOOD FOREST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-6038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-526-0001
Provider Business Mailing Address Fax Number:
225-765-9196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4801 AMBASSADOR CAFFERY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-470-2605
Provider Business Practice Location Address Fax Number:
337-470-4595
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  MD18859 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 310000 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 024038600 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4384446 . This is a "AETNA NON HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5460-0037 . This is a "BS NCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 252153 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1052462 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112523 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 161381200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4384525 . This is a "AENA NON-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5460-0102 . This is a "BS NCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 603962-01 . This is a "BS OF MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 250007826 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: DCA0018859 . This is a "BC NCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 325793 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 494972 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 814510 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 489391005 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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