Healthcare Provider Details

I. General information

NPI: 1134113889
Provider Name (Legal Business Name): PATRICK J CONNOLLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET 3 SILVERSTEIN BLDG.
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

1865 ROUTE 70 EAST
CHERRY HILL NJ
08003-2013
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3487
  • Fax: 215-349-5534
Mailing address:
  • Phone: 215-662-3487
  • Fax: 215-349-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD430407
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number25MA08681400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: