Basic Information
| Provider Information | |||||||||
| NPI: | 1518997923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONWAY | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 344 | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271020344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162255 | ||||||||
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| Practice Location | |||||||||
| Address1: | MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WINSTON-SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162255 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 04/24/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2002-00669 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 2002-00669 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RI0008X | 2002-00669 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology |
ID Information
| ID | Type | State | Issuer | Description | 190034 | 01 | NC | MEDCOST | OTHER | 1318R | 01 | NC | BCBS | OTHER | 3810007317 | 05 | WV | MEDICAID | 808471 | 01 | NC | PARTNERS | OTHER | 7520309 | 01 | NC | AETNA | OTHER | 10389755 | 05 | VA | MEDICAID | 891318R | 05 | NC | MEDICAID |