Provider Demographics
NPI:1396706289
Name:CONLEY, MARY GAFFNEY (M D)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GAFFNEY
Last Name:CONLEY
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 KNIGHTDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6505
Mailing Address - Country:US
Mailing Address - Phone:919-261-8760
Mailing Address - Fax:919-261-8765
Practice Address - Street 1:6905 KNIGHTDALE BLVD
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6505
Practice Address - Country:US
Practice Address - Phone:919-261-8760
Practice Address - Fax:919-261-8765
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000-00754207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891277WMedicaid
NC891277WMedicaid
NC22281152CMedicare PIN