Basic Information
| Provider Information | |||||||||
| NPI: | 1629002373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONEJERO | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 SPRUCE LN | ||||||||
| Address2: | APARTMENT #6 | ||||||||
| City: | NATICK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017604048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083341000 | ||||||||
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| Practice Location | |||||||||
| Address1: | UMASS MEDICAL SCHOOL | ||||||||
| Address2: | 55 LAKE AVENUE NORTH | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083341000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 208200000X | 224187 | MA | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.