Provider Demographics
NPI:1730180951
Name:VALDES, CONRADO A (MD)
Entity type:Individual
Prefix:
First Name:CONRADO
Middle Name:A
Last Name:VALDES
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 1:763 JOHNSONBURG RD
Mailing Address - Street 2:ERPG ANESTHESIA SERVICES
Mailing Address - City:ST MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3417
Mailing Address - Country:US
Mailing Address - Phone:814-788-8189
Mailing Address - Fax:814-788-8387
Practice Address - Street 1:763 JOHNSONBURG RD
Practice Address - Street 2:ERPG ANESTHESIA SERVICES
Practice Address - City:ST MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3417
Practice Address - Country:US
Practice Address - Phone:814-788-8189
Practice Address - Fax:814-788-8387
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037357L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018557990001Medicaid
PA0008473230005Medicaid
PA0008473230005Medicaid
PA099824Medicare ID - Type Unspecified