Individual
JACQUES R CONAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11107 CATHAGE RD UNIT 201, BERLIN, MD 21811-2156
(410) 912-6825
(410) 912-6827
Mailing address
100 E CARROLL ST, SALISBURY, MD 21801-5493
(410) 546-6400
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
D0055034
MD
207RP1001X
Pulmonary Disease Physician
Primary
D0055034
MD
207RS0012X
Sleep Medicine (Internal Medicine) Physician
D0055034
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0017 E554
BLUE CHOICE/FEP
MD
01
—
1937706
UNITED HEALTHCARE
—
01
—
290012458
RAILROAD MEDICARE
—
01
—
296540
MAMSI
—
01
—
4800365
UNITED HEALTHCARE MCO
—
01
—
76926302 420A
BLUE SHIELD
MD
Enumeration date
10/05/2006
Last updated
09/29/2022
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