Healthcare Provider Details

I. General information

NPI: 1932291663
Provider Name (Legal Business Name): CARMINE G MCCONNELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COIT RD STE D
PLANO TX
75075-3773
US

IV. Provider business mailing address

14308 HUGHES LN
DALLAS TX
75254-8502
US

V. Phone/Fax

Practice location:
  • Phone: 972-985-7100
  • Fax: 972-964-0281
Mailing address:
  • Phone: 972-385-9388
  • Fax: 972-964-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG9495
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: