Basic Information
| Provider Information | |||||||||
| NPI: | 1528599511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONNER | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | ALEXANDER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1215 LEE ST | ||||||||
| Address2: | BOX 800793 | ||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229080816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349241955 | ||||||||
| FaxNumber: | 4349821841 | ||||||||
| Practice Location | |||||||||
| Address1: | 17722 TALBOT RD S | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980555744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256903479 | ||||||||
| FaxNumber: | 4256909479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2017 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0101271555 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD61244542 | WA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.