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General NPI Number Information
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NPI Number | 1457352544
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Entity Type | Individual
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Provider Name | JOHN KINGSBURY CONANT JR. MD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 60 WESTWOOD AVE STE 230
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City | WATERBURY
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State | CT
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Zip | 06708-2460
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Country | US
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Telephone | 203-753-2800
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Fax | 203-753-7026
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Provider Business Mailing Address
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Address Line | 60 WESTWOOD AVE STE 230
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City | WATERBURY
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State | CT
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Zip | 06708-2460
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Country | US
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Telephone | 203-753-2800
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Fax | 203-753-7026
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 22969
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License Number State | CT
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