Provider Demographics
NPI:1659440279
Name:CONWAY, BRIAN P (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:CONWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17 N MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2344
Mailing Address - Country:US
Mailing Address - Phone:540-213-7725
Mailing Address - Fax:540-213-7481
Practice Address - Street 1:676A BERKMAR CIRCLE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901
Practice Address - Country:US
Practice Address - Phone:434-220-8001
Practice Address - Fax:434-220-8010
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101029965207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006376983Medicaid
VA181947549OtherRR MEDICARE
VAB05025Medicare UPIN
VA006376983Medicaid