Provider Demographics
NPI:1760436950
Name:GEORGE W CONNER, MD
Entity Type:Organization
Organization Name:GEORGE W CONNER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-484-0173
Mailing Address - Street 1:17 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-7080
Mailing Address - Country:US
Mailing Address - Phone:716-484-0173
Mailing Address - Fax:716-484-0177
Practice Address - Street 1:17 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-7080
Practice Address - Country:US
Practice Address - Phone:716-484-0173
Practice Address - Fax:716-484-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139892208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB82210Medicare UPIN
NYAA0878Medicare ID - Type UnspecifiedGROUP #