Provider Demographics
NPI:1447232079
Name:CONLEY, THOMAS EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EUGENE
Last Name:CONLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:10420 LITTLE PATUXENT PKWY
Mailing Address - Street 2:STE 250
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3638
Mailing Address - Country:US
Mailing Address - Phone:410-740-5186
Mailing Address - Fax:410-740-2371
Practice Address - Street 1:10420 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE#250
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3533
Practice Address - Country:US
Practice Address - Phone:410-740-5186
Practice Address - Fax:410-740-2371
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00609682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003559900Medicaid
MD003559900Medicaid
PA113483WWPMedicare PIN
DC016568I64Medicare PIN
MD337P664GMedicare PIN