Healthcare Provider Details

I. General information

NPI: 1700175940
Provider Name (Legal Business Name): EMILIA K. CONNOLLY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMI CONNOLLY

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 HARRISON AVE. 4TH FL MENINO BLDG
BOSTON MA
02118
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE STE 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1028154
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1028154
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS016900
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.012799
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS016900
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: