Healthcare Provider Details

I. General information

NPI: 1982777033
Provider Name (Legal Business Name): DEBORAH J. CONWAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 MINNESOTA DR
EDINA MN
55435-7979
US

IV. Provider business mailing address

3600 MINNESOTA DR
EDINA MN
55435-7979
US

V. Phone/Fax

Practice location:
  • Phone: 952-595-1301
  • Fax: 612-294-4903
Mailing address:
  • Phone: 952-595-1301
  • Fax: 612-294-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number321346
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number049487
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME140799
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: