Provider Demographics
NPI:1679547988
Name:CONARD, BARTH T (MD)
Entity type:Individual
Prefix:
First Name:BARTH
Middle Name:T
Last Name:CONARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6443 OXBOW WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-7108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8177 CLEARVISTA PKWY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1662
Practice Address - Country:US
Practice Address - Phone:317-621-7801
Practice Address - Fax:317-621-7205
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028117A207X00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01197279OtherRR MEDICARE PTAN
IN100063580AMedicaid
INP01197279OtherRR MEDICARE PTAN
IND51031Medicare UPIN
IN0841100001Medicare NSC
INM400052204Medicare PIN
IN0854000002Medicare NSC
INM400052200Medicare PIN
IN230940EMedicare PIN
INM400052199Medicare PIN
INM400052203Medicare PIN
INM400052202Medicare PIN
IN100063580AMedicaid