Healthcare Provider Details

I. General information

NPI: 1023310281
Provider Name (Legal Business Name): EILEEN M CONAWAY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2010
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 NC-54 SUITE 102
DURHAM NC
27707
US

IV. Provider business mailing address

161 BIG BRADLEY DR
WENDELL NC
27591-3357
US

V. Phone/Fax

Practice location:
  • Phone: 919-438-2293
  • Fax:
Mailing address:
  • Phone: 757-373-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS11407
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024-01747
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83430
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number83430
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS11407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: