MEDICARE: DR. RICHARD P CONNELLY 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	208D00000X	General Practice Physician	11498	PR

General Provider Information

NPI Number	:	1760475644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD P CONNELLY M.D.

Provider Business Mailing Address
First Line	:	221 CALLE THEBE
Second Line	:	PASEO DEL SOL
City	:	DORADO
State	:	PR
Zip	:	00646-4668
Country	:	US
Telephone Number	:	787-278-1985
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 CALLE THEBE
Second Line	:	PASEO DEL SOL
City	:	DORADO
State	:	PR
Zip	:	00646-4668
Country	:	US
Telephone Number	:	787-278-1985
Fax Number	:

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	06/01/2015

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