MEDICARE: DIANE HUNTINGTON CONLEY 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	2085R0202X	Diagnostic Radiology Physician	0101041788	VA
2	2085R0202X	Diagnostic Radiology Physician	2008-01875	NC

General Provider Information

NPI Number	:	1528032604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE HUNTINGTON CONLEY MD

Provider Business Mailing Address
First Line	:	336 BURTONWOOD DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-4054
Country	:	US
Telephone Number	:	952-595-1301
Fax Number	:	612-294-4903

Provider Business Practice Location Address
First Line	:	3815 STONEY RIDGE TRL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-6932
Country	:	US
Telephone Number	:	952-595-1100
Fax Number	:	612-294-4903

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	08/30/2017

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