Basic Information
| Provider Information | |||||||||
| NPI: | 1992766174 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KONRAD | ||||||||
| FirstName: | HINDOLA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 218 | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068130218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037940117 | ||||||||
| FaxNumber: | 2037906738 | ||||||||
| Practice Location | |||||||||
| Address1: | 57 NORTH ST | ||||||||
| Address2: | SUITE 415 | ||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068105660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037940117 | ||||||||
| FaxNumber: | 2037906738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 200770-1 | NY | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 037958 | CT | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | P2577527 | 01 | CT | OXFORD | OTHER | 001379587 | 05 | CT | MEDICAID |