Individual
DR. CHARLES JOSEPH CONLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1396 PICCARD DR, KAISER PERMANENTE SHADY GROVE MEDICAL CENTER, ROCKVILLE, MD 20850-4302
(301) 548-5700
Mailing address
2101 E JEFFERSON ST, KAISER PERMANENTE MEDICARE ENROLLMENT, ROCKVILLE, MD 20852-4908
(301) 816-2424
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
D54729
MD
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
MD15263
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028082100
—
DC
05
—
205000500
—
MD
05
—
6730230
—
VA
Enumeration date
10/18/2006
Last updated
12/06/2012
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