Healthcare Provider Details

I. General information

NPI: 1275910408
Provider Name (Legal Business Name): MAURA CONWAY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MOUNT PLEASANT RD
NEWTOWN CT
06470-1408
US

IV. Provider business mailing address

90 S MAIN ST
MIDDLETOWN CT
06457-3649
US

V. Phone/Fax

Practice location:
  • Phone: 203-426-1818
  • Fax:
Mailing address:
  • Phone: 860-358-6486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number62310
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number62310
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: