MEDICARE: DR. JOHN KINGSBURY CONANT JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	22969	CT

General Provider Information

NPI Number	:	1457352544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN KINGSBURY CONANT JR. MD

Provider Business Mailing Address
First Line	:	60 WESTWOOD AVE
Second Line	:	STE 230
City	:	WATERBURY
State	:	CT
Zip	:	06708-2460
Country	:	US
Telephone Number	:	203-753-2800
Fax Number	:	203-753-7026

Provider Business Practice Location Address
First Line	:	60 WESTWOOD AVE
Second Line	:	STE 230
City	:	WATERBURY
State	:	CT
Zip	:	06708-2460
Country	:	US
Telephone Number	:	203-753-2800
Fax Number	:	203-753-7026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/25/2012

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