Provider Demographics
NPI:1497928865
Name:CHRISTOPHER W. CONAVAY, M.D., P.A.
Entity Type:Organization
Organization Name:CHRISTOPHER W. CONAVAY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:CONAVAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:407-447-5370
Mailing Address - Street 1:2304 ALOMA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3330
Mailing Address - Country:US
Mailing Address - Phone:407-447-5370
Mailing Address - Fax:
Practice Address - Street 1:2304 ALOMA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3330
Practice Address - Country:US
Practice Address - Phone:407-447-5370
Practice Address - Fax:407-447-4385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 42102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL36366OtherMEDICARE ID
211221OtherAVMED
2296561OtherCIGNA
0994080OtherAETNA
FLD26839Medicare UPIN