Provider Demographics
NPI:1538205372
Name:KEVIN E. CONBOY, MD
Entity type:Organization
Organization Name:KEVIN E. CONBOY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONBOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-622-9102
Mailing Address - Street 1:38 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4515
Mailing Address - Country:US
Mailing Address - Phone:203-622-9102
Mailing Address - Fax:203-622-0508
Practice Address - Street 1:38 LAKE AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4515
Practice Address - Country:US
Practice Address - Phone:203-622-9102
Practice Address - Fax:203-622-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty