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General NPI Number Information
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NPI Number | 1053393934
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Entity Type | Individual
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Provider Name | ROBERT J MCCONNELL D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 107 KENBROOK DR
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City | VANDALIA
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State | OH
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Zip | 45377-2427
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Country | US
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Telephone | 937-890-1725
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Fax | 937-890-1725
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Provider Business Mailing Address
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Address Line | P.O. BOX 235
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City | VANDALIA
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State | OH
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Zip | 45377-2427
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Country | US
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Telephone | 937-890-1725
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Fax | 937-890-1725
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | OH34001569
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License Number State | OH
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