1528019387 NPI number — MATTHEW A CONWAY MD

Table of content: MATTHEW A CONWAY MD (NPI 1528019387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528019387 NPI number — MATTHEW A CONWAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONWAY
Provider First Name:
MATTHEW
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528019387
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 STRATTON ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUTLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05701-4621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-775-1903
Provider Business Mailing Address Fax Number:
802-775-5503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 STRATTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUTLAND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05701-4621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-775-1903
Provider Business Practice Location Address Fax Number:
802-775-5503
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  0420009840 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 020042452 . This is a "MRR" identifier . This identifiers is of the category "OTHER".
  • Identifier: OVN1990 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030235856012 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 619320 . This is a "TRGON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 319889 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8000469 . This is a "LF LADIES FIRST" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 189383 . This is a "HS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 28407 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00039889 . This is a "VT BS" identifier . This identifiers is of the category "OTHER".




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