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General NPI Number Information
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NPI Number | 1083973374
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Entity Type | Individual
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Provider Name | RYAN O'CONNELL D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2012
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 120 SOUTH MAIN STREET
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City | DANVILLE
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State | VA
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Zip | 24541
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Country | US
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Telephone | 315-723-4320
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Fax |
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Provider Business Mailing Address
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Address Line | 955 ROCKY KNOLL LN
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City | DANVILLE
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State | VA
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Zip | 24541-8900
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Country | US
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Telephone | 315-723-4320
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 280169
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0116024095
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License Number State | VA
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