Healthcare Provider Details

I. General information

NPI: 1477660314
Provider Name (Legal Business Name): CHRISTINE M CONLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4844 GEORGE WASHINGTON HWY SUITE 8
WHITE MARSH VA
23183-0129
US

IV. Provider business mailing address

860 OMNI BLVD SUITE 303
NEWPORT NEWS VA
23606
US

V. Phone/Fax

Practice location:
  • Phone: 804-693-0042
  • Fax: 804-693-0625
Mailing address:
  • Phone: 757-232-8777
  • Fax: 757-232-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0420009406
License Number StateVT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierOVN1489
Identifier TypeMEDICAID
Identifier StateVT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: