Organization
EDYTA M KONRAD MD, PHD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDYTA MARIA KONRAD MD, PHD (OWNER)
(508) 460-6002
Entity
Organization
Contact information
Practice address
320 BOLTON ST, OFIICE # 100, MARLBOROUGH, MA 01752-3988
(508) 460-6002
(508) 460-6028
Mailing address
320 BOLTON ST, OFIICE # 100, MARLBOROUGH, MA 01752-3988
(508) 460-6002
(508) 460-6028
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
207R00000X
Internal Medicine Physician
Primary
157585
MA
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110037908A
—
MA
Enumeration date
08/12/2016
Last updated
08/12/2016
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