Provider Demographics
NPI:1730238908
Name:KING, CONRAD K JR (MD, PA)
Entity type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:K
Last Name:KING
Suffix:JR
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PEOPLES PLZ
Mailing Address - Street 2:SUITE 233
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5707
Mailing Address - Country:US
Mailing Address - Phone:302-838-5600
Mailing Address - Fax:302-838-5601
Practice Address - Street 1:1400 PEOPLES PLZ
Practice Address - Street 2:SUITE 233
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5707
Practice Address - Country:US
Practice Address - Phone:302-838-5600
Practice Address - Fax:302-838-5601
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100045412081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE122143Medicare ID - Type Unspecified
DED75923Medicare UPIN