Provider Demographics
NPI:1457536112
Name:MARY CONWAY,MD PA
Entity Type:Organization
Organization Name:MARY CONWAY,MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-940-1174
Mailing Address - Street 1:330 N MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4934
Mailing Address - Country:US
Mailing Address - Phone:252-940-1174
Mailing Address - Fax:252-940-1176
Practice Address - Street 1:330 N MARKET S
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4934
Practice Address - Country:US
Practice Address - Phone:252-940-1174
Practice Address - Fax:252-940-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500870207R00000X
NC95-00870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC23825OtherBCBS
NC8923825Medicaid
2217903CMedicare PIN
NC23825OtherBCBS
NCG16136Medicare UPIN
NC2217903CMedicare PIN