Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | MD061676-L | PA |
NPI | 1043274376 |
---|---|
Provider Name | Dr. Daniel Henry Conway |
First Address | Philadelphia, PA 19134 |
Second Address | Philadelphia, PA 19134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 29/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0018142830003 | (05) | PA |
043969 | HCFA PIN (01) | PW |
061676-L | STATE MEDICAL LICENSE (01) | PA |
BC6852138 | DEA LICENSE (01) | PA |
H28919 | (02) | PA |