Healthcare Provider Details

I. General information

NPI: 1548758337
Provider Name (Legal Business Name): WILLIAM K. CONAWAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 WHITE PLAINS RD STE 105&106
TRUMBULL CT
06611-4552
US

IV. Provider business mailing address

2408 WHITNEY AVE
HAMDEN CT
06518-3209
US

V. Phone/Fax

Practice location:
  • Phone: 203-654-2518
  • Fax: 203-799-8058
Mailing address:
  • Phone: 203-626-0160
  • Fax: 203-294-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number78821
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: