Provider Demographics
NPI:1457872806
Name:MATTHEW CONNER MD PLLC
Entity type:Organization
Organization Name:MATTHEW CONNER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-797-0953
Mailing Address - Street 1:5842 FAYETTEVILLE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6294
Mailing Address - Country:US
Mailing Address - Phone:919-797-0953
Mailing Address - Fax:919-797-0981
Practice Address - Street 1:5842 FAYETTEVILLE RD STE 110
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6294
Practice Address - Country:US
Practice Address - Phone:919-797-0953
Practice Address - Fax:919-797-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-001202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty