Provider Demographics
NPI:1437245362
Name:CONAWAY, JACQUES R (MD)
Entity Type:Individual
Prefix:
First Name:JACQUES
Middle Name:R
Last Name:CONAWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5493
Mailing Address - Country:US
Mailing Address - Phone:410-546-6400
Mailing Address - Fax:
Practice Address - Street 1:11107 CATHAGE RD UNIT 201
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-2156
Practice Address - Country:US
Practice Address - Phone:410-912-6825
Practice Address - Fax:410-912-6827
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055034207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0017 E554OtherBLUE CHOICE/FEP
4800365OtherUNITED HEALTHCARE MCO
290012458OtherRAILROAD MEDICARE
MD76926302 420AOtherBLUE SHIELD
1937706OtherUNITED HEALTHCARE
296540OtherMAMSI
296540OtherMAMSI
MDK531558YMedicare ID - Type Unspecified