Provider Demographics
NPI:1598700692
Name:CONWAY, ADA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:M
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-8227
Mailing Address - Country:US
Mailing Address - Phone:910-385-7551
Mailing Address - Fax:
Practice Address - Street 1:403 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2399
Practice Address - Country:US
Practice Address - Phone:910-592-6011
Practice Address - Fax:910-590-0816
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01080208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5483676OtherAETNA
NC00365518Medicaid
NC182933OtherMEDCOST
NC140RHOtherNC BLUE CROSS BLUE SHIELD
NC1944154OtherUNITED HEALTHCARE
NC9104294OtherCIGNA
NC1944154OtherUNITED HEALTHCARE
NC2046734Medicare ID - Type Unspecified