Provider Demographics
NPI:1457352544
Name:CONANT, JOHN KINGSBURY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KINGSBURY
Last Name:CONANT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WESTWOOD AVE
Mailing Address - Street 2:STE 230
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2460
Mailing Address - Country:US
Mailing Address - Phone:203-753-2800
Mailing Address - Fax:203-753-7026
Practice Address - Street 1:60 WESTWOOD AVE
Practice Address - Street 2:STE 230
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2460
Practice Address - Country:US
Practice Address - Phone:203-753-2800
Practice Address - Fax:203-753-7026
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT22969208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT340000230Medicare ID - Type Unspecified
D03065Medicare UPIN