MEDICARE: DAVID O'CONNELL MD

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	207R00000X	Internal Medicine Physician	35-082498	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568455335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID O'CONNELL MD

Provider Business Mailing Address
First Line	:	9275 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-7779
Country	:	US
Telephone Number	:	513-936-4510
Fax Number	:	513-936-4511

Provider Business Practice Location Address
First Line	:	9275 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-7779
Country	:	US
Telephone Number	:	513-936-4510
Fax Number	:	513-936-4511

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	11/13/2013

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