Basic Information
| Provider Information | |||||||||
| NPI: | 1861414633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONRAD | ||||||||
| FirstName: | ERICH | ||||||||
| MiddleName: | JOSEF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1340 POYDRAS ST | ||||||||
| Address2: | SUITE 1640 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701121221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044121835 | ||||||||
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| Practice Location | |||||||||
| Address1: | BEHAVIORAL SCIENCE CENTER | ||||||||
| Address2: | 3450 CHESTNUT STREET, 3RD FLOOR | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044121580 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 10/23/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 025408 | LA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1575135 | 05 | LA | MEDICAID |