Active NPI
Ellen Davis Conroy, DO
- Psychiatry Physician
- Philadelphia, PA
National Provider Identifier
1477585834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- OS005839L
- Practice address
- 3900 Woodland Ave
Pvamc Department of Behavioral Health
Philadelphia, PA 19104-4551 - Phone
- (215) 823-5800
- NPI assigned
- Jul 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS005839L | PA | |
| Psychiatry Physician | 2084P0800X | OS005839L | PA | Primary |
| Addiction Psychiatry Physician | 2084P0802X | OS005839L | PA |
Addresses
Primary practice location
3900 Woodland Ave
Pvamc Department of Behavioral Health
Philadelphia, PA 19104-4551
Mailing address
3900 Woodland Ave
Pvamc Department of Behavioral Health
Philadelphia, PA 19104-4551
Phone (215) 823-5800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0010727570001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS005839L | PA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384473600000",
"number": "1477585834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3900 WOODLAND AVE",
"address_2": "PVAMC DEPARTMENT OF BEHAVIORAL HEALTH",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044551",
"telephone_number": "215-823-5800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 WOODLAND AVE",
"address_2": "PVAMC DEPARTMENT OF BEHAVIORAL HEALTH",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044551",
"telephone_number": "215-823-5800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONROY",
"first_name": "ELLEN",
"middle_name": "DAVIS",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-07",
"last_updated": "2013-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "OS005839L",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "OS005839L",
"primary": true
},
{
"code": "2084P0802X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Psychiatry",
"state": "PA",
"license": "OS005839L",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0010727570001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.