Healthcare Provider Details

I. General information

NPI: 1821315250
Provider Name (Legal Business Name): EMILY O'CONNELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2010
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BRAMBLE BUSH DR
FALMOUTH MA
02540-2325
US

IV. Provider business mailing address

2 BRAMBLE BUSH DR
FALMOUTH MA
02540-2325
US

V. Phone/Fax

Practice location:
  • Phone: 508-540-1801
  • Fax:
Mailing address:
  • Phone: 508-540-1801
  • Fax: 504-540-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number254042
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: