Provider Demographics
NPI:1841249117
Name:CONNER, GEORGE W (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:CONNER
Suffix:
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 1:17 SHERMAN ST
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-7080
Mailing Address - Country:US
Mailing Address - Phone:716-484-0173
Mailing Address - Fax:716-484-0177
Practice Address - Street 1:17 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701
Practice Address - Country:US
Practice Address - Phone:716-484-0173
Practice Address - Fax:716-484-0177
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139892208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010261801OtherUNIVERA HEALTHCARE
NY1706450OtherINDEPENDENT HEALTH
NY000508598003OtherBLUE CROSS BLUE SHIELD
NY00686815Medicaid
B82210Medicare UPIN
38828BMedicare ID - Type Unspecified