Healthcare Provider Details

I. General information

NPI: 1114939980
Provider Name (Legal Business Name): KATHY EDWINA O'CONNELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11842 ROCK LANDING DR STE 115
NEWPORT NEWS VA
23606-4437
US

IV. Provider business mailing address

11842 ROCK LANDING DR STE 115
NEWPORT NEWS VA
23606-4437
US

V. Phone/Fax

Practice location:
  • Phone: 757-505-9905
  • Fax: 757-595-5377
Mailing address:
  • Phone: 757-505-9905
  • Fax: 757-595-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101048159
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: