Provider Demographics
NPI:1528051687
Name:CONWAY, MELANIE W (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:W
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 N PIERCE ST STE 307
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5377
Mailing Address - Country:US
Mailing Address - Phone:501-773-3329
Mailing Address - Fax:331-204-0856
Practice Address - Street 1:1405 NORTH PIERCE
Practice Address - Street 2:SUITE 212
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207
Practice Address - Country:US
Practice Address - Phone:501-664-0091
Practice Address - Fax:501-664-0112
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-17632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G69234Medicare UPIN