Provider Demographics
NPI:1851356208
Name:CONLON, MICHELE B (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:B
Last Name:CONLON
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:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06501-0206
Mailing Address - Country:US
Mailing Address - Phone:203-397-8000
Mailing Address - Fax:203-389-1540
Practice Address - Street 1:71 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:860-647-6487
Practice Address - Fax:860-647-6447
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025761207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500HBL161CT02OtherBC/BS GRP# RGH
CTOR4388OtherHLTHNET
CT1104296OtherUHC
CT01025761OtherCIGNA
CTA524580OtherOXFORD
CTC009784OtherCHAMPUS/TRICARE
CTW1H29OtherEMPIRE BC
CT0004312983OtherAETNA
CT001257618Medicaid
CT500HBL161CT01OtherBC/BS GRP#
CT76164901OtherCTCARE
CT500HBL161CT02OtherBC/BS GRP# RGH
CT001257618Medicaid