1912981754 NPI number — DR. GILBERT REID CONLEY DPM

Table of content: DR. GILBERT REID CONLEY DPM (NPI 1912981754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912981754 NPI number — DR. GILBERT REID CONLEY DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONLEY
Provider First Name:
GILBERT
Provider Middle Name:
REID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CONLEY
Provider Other First Name:
G
Provider Other Middle Name:
REID
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1912981754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5311 LIMESTONE RD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19808-1222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-234-3907
Provider Business Mailing Address Fax Number:
302-234-3927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5311 LIMESTONE RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19808-1246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-234-3907
Provider Business Practice Location Address Fax Number:
302-234-3927
Provider Enumeration Date:
12/05/2005

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: 213E00000X , with the licence number:  E10000089 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0131X , with the licence number: E1-0000089 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4370221 . This is a "AETNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 117167 . This is a "AETNA HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000196317 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 249943 . This is a "MAMSI" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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