Individual
JOHN CHRISTIAN CONRAD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
4064 POSTAL DR, ROANOKE, VA 24018-6438
(540) 725-1226
(540) 857-5306
Mailing address
4064 POSTAL DR, ROANOKE, VA 24018-6438
(540) 725-1226
(540) 857-5306
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0110003758
VA
363AS0400X
Surgical Physician Assistant
Primary
0110003758
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043582422
SOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA
01
—
540506332115
TRICARE/CHAMPUS
VA
01
—
P01072820
RAILROAD MEDICARE
VA
Enumeration date
02/01/2012
Last updated
01/27/2022
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