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NPI Code Detail

MEDICARE: PHILIP J O'DONNELL MD

MEDICARE:   PHILIP J O'DONNELL  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
1207RC0000XCardiovascular Disease Physician0101028422VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
69318661OTHERWVMEDICARE GROUP
7C00075OTHERVAMEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13119593OTHERVAMAMSI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
408240900000OTHERVASOUTHERN HEALTH COVENTRY
5502802OTHERVANCPPO
8541003042003OTHERWVMOUNTAIN STATE BCBS
9014333OTHERVAANTHEM BCBS
1044245OTHERVASENTARA
11MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871596924
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILIP J O'DONNELL MD
Provider Business Mailing Address
First Line : 104 SELMA DR
Second Line :
City : WINCHESTER
State : VA
Zip : 22601-3834
Country : US
Telephone Number : 540-678-2800
Fax Number :
Provider Business Practice Location Address
First Line : 104 SELMA DR
Second Line :
City : WINCHESTER
State : VA
Zip : 22601-3834
Country : US
Telephone Number : 540-678-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 03/31/2021

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Directions to “ PHILIP J O'DONNELL MD” Practice Location

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