Provider Demographics
NPI:1053359893
Name:EHRLICH, CONRAD PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:PAUL
Last Name:EHRLICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:67 SAND PIT RD
Mailing Address - Street 2:NORTHEAST RADIOLOGY
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4032
Mailing Address - Country:US
Mailing Address - Phone:203-797-1770
Mailing Address - Fax:845-278-1613
Practice Address - Street 1:67 SAND PIT RD STE 105
Practice Address - Street 2:HOUSATONIC VALLEY RADIOLOGICAL ASSOC. PC
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4032
Practice Address - Country:US
Practice Address - Phone:203-797-1770
Practice Address - Fax:203-796-7839
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT025510174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB39256Medicare UPIN
CT300000356OtherMEDICARE PROVIDER NUMBER
CTC02436OtherOTHER PROVIDER IDENTIFIER
CTC00077OtherMEDICARE GROUP NUMBER
CTC01296OtherOTHER PROVIDER IDENTIFIER