Healthcare Provider Details

I. General information

NPI: 1699279554
Provider Name (Legal Business Name): JUSTIN CONNOR MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 S BRADFORD ST
DOVER DE
19904
US

IV. Provider business mailing address

518 HOLLY KNOLL RD
HOCKESSIN DE
19707-9749
US

V. Phone/Fax

Practice location:
  • Phone: 302-231-1245
  • Fax: 302-231-1246
Mailing address:
  • Phone: 302-483-7115
  • Fax: 302-483-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN CONNOR
Title or Position: PRESIDENT
Credential: MD
Phone: 314-495-8194