Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 25MA05786900 | NJ |
N | 207RG0100X | Gastroenterologist | MD040081E | PA |
NPI | 1013921576 |
---|---|
Provider Name | Andrew Randall Conn |
First Address | Charleston, SC 29401-5703 |
Second Address | Charleston, SC 29401-5703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 05/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5188709 | (05) | NJ |
F38656 | (02) |