Provider Demographics
NPI:1528019387
Name:CONWAY, MATTHEW A (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:CONWAY
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 1:241 STRATTON ROAD
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4621
Mailing Address - Country:US
Mailing Address - Phone:802-775-1903
Mailing Address - Fax:802-775-5503
Practice Address - Street 1:241 STRATTON ROAD
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4621
Practice Address - Country:US
Practice Address - Phone:802-775-1903
Practice Address - Fax:802-775-5503
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009840208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020042452OtherMRR
VTOVN1990Medicaid
030235856012OtherCIGNA
619320OtherTRGON
319889OtherMVP
VT8000469OtherLF LADIES FIRST
189383OtherHS
28407OtherCIGNA
00039889OtherVT BS
00039889OtherVT BS
030235856012OtherCIGNA