NPIMap

Organization Active NPI

Edyta M Konrad MD, PHD

  • Internal Medicine Physician
  • Marlborough, MA
National Provider Identifier
1417401993
Registry record updated Aug 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
157585 Issued in MA
Legal business name
EDYTA M KONRAD MD, PHD
Practice address
320 Bolton St
Ofiice # 100
Marlborough, MA 01752-3988
Phone
(508) 460-6002
Fax
(508) 460-6028
NPI assigned
Aug 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Edyta Maria Konrad, MD, PHDNPI 1578677472
Title
Owner
Phone
(508) 460-6002

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Education NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133NN1002X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 157585 MA Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

320 Bolton St
Ofiice # 100
Marlborough, MA 01752-3988

Mailing address

320 Bolton St
Ofiice # 100
Marlborough, MA 01752-3988
Phone (508) 460-6002

Other identifiers 1

IdentifierTypeStateIssuer
110037908AMedicaidMA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470960000000",
    "number": "1417401993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 BOLTON ST",
            "address_2": "OFIICE # 100",
            "city": "MARLBOROUGH",
            "state": "MA",
            "postal_code": "017523988",
            "telephone_number": "508-460-6002",
            "fax_number": "508-460-6028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 BOLTON ST",
            "address_2": "OFIICE # 100",
            "city": "MARLBOROUGH",
            "state": "MA",
            "postal_code": "017523988",
            "telephone_number": "508-460-6002",
            "fax_number": "508-460-6028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDYTA M KONRAD MD, PHD",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-12",
        "last_updated": "2016-08-12",
        "status": "A",
        "authorized_official_last_name": "KONRAD",
        "authorized_official_first_name": "EDYTA",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-460-6002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "157585",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110037908A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlborough, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.