Healthcare Provider Details

I. General information

NPI: 1417932542
Provider Name (Legal Business Name): JOHN J. O'CONNELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 STATE ST
NORTHAMPTON MA
01060-3049
US

IV. Provider business mailing address

69 STATE ST
NORTHAMPTON MA
01060-3049
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-8156
  • Fax:
Mailing address:
  • Phone: 413-586-8156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number153367
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number153367
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: