Provider Demographics
NPI:1225250681
Name:CONANT UROLOGY, LLC
Entity Type:Organization
Organization Name:CONANT UROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CONANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:203-753-2800
Mailing Address - Street 1:60 WESTWOOD AVENUE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WATERBURY
Mailing Address - State:TN
Mailing Address - Zip Code:06708-2460
Mailing Address - Country:US
Mailing Address - Phone:203-753-2800
Mailing Address - Fax:203-753-7026
Practice Address - Street 1:60 WESTWOOD AVENUE
Practice Address - Street 2:SUITE 230
Practice Address - City:WATERBURY
Practice Address - State:DC
Practice Address - Zip Code:06708-2460
Practice Address - Country:US
Practice Address - Phone:203-753-2800
Practice Address - Fax:203-753-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT22969208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1229699Medicaid
CT1229699Medicaid