Basic Information
| Provider Information | |||||||||
| NPI: | 1710156229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONWAY | ||||||||
| FirstName: | ANITA | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5800 MONROE ST | ||||||||
| Address2: | BLDG E SUITE 4 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198243433 | ||||||||
| FaxNumber: | 4198240216 | ||||||||
| Practice Location | |||||||||
| Address1: | 5800 MONROE ST | ||||||||
| Address2: | BLDG E STE 4 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198243433 | ||||||||
| FaxNumber: | 4198240216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2008 | ||||||||
| LastUpdateDate: | 02/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35090456 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.