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NPI Code Detail

MEDICARE: MICHAEL D CONNOLLY MD

MEDICARE: MICHAEL D CONNOLLY 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
1208600000XSurgery PhysicianMD12986RI

General Provider Information

NPI Number : 1841410743
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL D CONNOLLY MD
Provider Business Mailing Address
First Line : 455 TOLL GATE ROAD
Second Line : PRC AND CREDENTIALING
City : WARWICK
State : RI
Zip : 02886-2759
Country : US
Telephone Number : 401-273-0641
Fax Number : 401-273-2919
Provider Business Practice Location Address
First Line : 455 TOLL GATE ROAD
Second Line : ASP BUILDING
City : WARWICK
State : RI
Zip : 02886-2759
Country : US
Telephone Number : 401-738-6611
Fax Number : 401-921-6952
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2007
Last Update Date : 03/27/2026

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