Healthcare Provider Details

I. General information

NPI: 1811542749
Provider Name (Legal Business Name): O'DONNELL ORTHOPAEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 HAMILTON ST STE 214
ALLENTOWN PA
18104-6329
US

IV. Provider business mailing address

702 N 3RD ST # 804
PHILADELPHIA PA
19123-2904
US

V. Phone/Fax

Practice location:
  • Phone: 484-273-0401
  • Fax:
Mailing address:
  • Phone: 267-639-2555
  • Fax: 215-613-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN O'DONNELL
Title or Position: OWNER
Credential: MD
Phone: 267-639-2555