Provider Demographics
NPI:1639153489
Name:CONFORTI, JOHN FRANK (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANK
Last Name:CONFORTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 LYNDHURST AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4007
Mailing Address - Country:US
Mailing Address - Phone:336-765-0383
Mailing Address - Fax:336-760-6918
Practice Address - Street 1:3001 LYNDHURST AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4007
Practice Address - Country:US
Practice Address - Phone:336-765-0383
Practice Address - Fax:336-760-6918
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96 00493207RP1001X, 207RC0200X
NC9600493207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8923901Medicaid
WV1810789000Medicaid
NC23901OtherBCBS
VA5885931Medicaid
SCQ0049IMedicaid
NC5298321OtherAETNA
NC802063OtherPARTNERS
NCC0869OtherMEDCOST
NC5298321OtherAETNA
F96558Medicare UPIN
NC2225548BMedicare PIN