=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346592862
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN MARY O'CONNELL M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2012
-----------------------------------------------------
Last Update Date | 10/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 STONECROP LN
-----------------------------------------------------
City | WILTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06897-2405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-761-1106
-----------------------------------------------------
Fax | 203-803-9318
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 STONECROP LN
-----------------------------------------------------
City | WILTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06897-2405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-761-1106
-----------------------------------------------------
Fax | 203-803-9318
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 030733
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------