Healthcare Provider Details

I. General information

NPI: 1396706289
Provider Name (Legal Business Name): MARY GAFFNEY CONLEY M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 KNIGHTDALE BLVD
KNIGHTDALE NC
27545-6505
US

IV. Provider business mailing address

6905 KNIGHTDALE BLVD
KNIGHTDALE NC
27545-6505
US

V. Phone/Fax

Practice location:
  • Phone: 919-261-8760
  • Fax: 919-261-8765
Mailing address:
  • Phone: 919-261-8760
  • Fax: 919-261-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2000-00754
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: