Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 018275 | CT |
NPI | 1053415505 |
---|---|
Provider Name | Michael Conway |
First Address | Rocky Hill, CT 06067-0587 |
Second Address | Hartford, CT 06106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00118275700 | (05) | CT |
B37706 | (02) | CT |