Provider Demographics
NPI:1437180981
Name:CONRAD, DEBORAH A (PA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2638 PEARL STREET RD
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9634
Mailing Address - Country:US
Mailing Address - Phone:585-762-4832
Mailing Address - Fax:
Practice Address - Street 1:5762 E MAIN STREET RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-9649
Practice Address - Country:US
Practice Address - Phone:585-201-7055
Practice Address - Fax:585-219-6140
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY009356-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02670042Medicaid
NY02670042Medicaid
NYQ34961Medicare UPIN