Provider Demographics
NPI:1790727667
Name:CONWAY, ANIKKE M (MD)
Entity Type:Individual
Prefix:
First Name:ANIKKE
Middle Name:M
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANIKKE
Other - Middle Name:M
Other - Last Name:CENGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 751274
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1274
Mailing Address - Country:US
Mailing Address - Phone:919-470-8490
Mailing Address - Fax:
Practice Address - Street 1:3643 N ROXBORO ST
Practice Address - Street 2:WATTS BLDG. 3RD FLOOR
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2702
Practice Address - Country:US
Practice Address - Phone:919-470-8490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016449207R00000X
NC2013-00163207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME0622Medicare ID - Type Unspecified
MEI06978Medicare UPIN