MEDICARE: PATRICIA A CONNOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	35-05-7614-C	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487614400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA A CONNOR M.D.

Provider Business Mailing Address
First Line	:	453 WATERBURY CT
Second Line	:	SUITE 220
City	:	GAHANNA
State	:	OH
Zip	:	43230-5309
Country	:	US
Telephone Number	:	614-471-0652
Fax Number	:	614-509-6001

Provider Business Practice Location Address
First Line	:	453 WATERBURY CT
Second Line	:	SUITE 220
City	:	GAHANNA
State	:	OH
Zip	:	43230-5309
Country	:	US
Telephone Number	:	614-471-0652
Fax Number	:	614-509-6001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/08/2007

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