Healthcare Provider Details

I. General information

NPI: 1982774618
Provider Name (Legal Business Name): FREDERICK V O'CONNOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MAIN ST
UNIONVILLE CT
06085-1131
US

IV. Provider business mailing address

101 MAIN ST P.O. BOX 221
UNIONVILLE CT
06085-1131
US

V. Phone/Fax

Practice location:
  • Phone: 860-673-6124
  • Fax: 860-673-3290
Mailing address:
  • Phone: 860-673-6124
  • Fax: 860-673-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18190
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: