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General NPI Number Information
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NPI Number | 1184758070
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Entity Type | Organization
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Legal Business Name | LEO P O'CONNELL MD PC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11835 FISHING POINT DR SUITE 201
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2584
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Country | US
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Telephone | 757-873-8823
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Fax | 757-873-6742
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Provider Business Mailing Address
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Address Line | 11835 FISHING POINT DR SUITE 201
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2584
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Country | US
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Telephone | 757-873-8823
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Fax | 757-873-6742
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEO P O'CONNELL
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Credential | MD
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Telephone | 757-873-8823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101024069
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License Number State | VA
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