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General NPI Number Information
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NPI Number | 1699018044
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Entity Type | Individual
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Provider Name | MATTHEW WELLS MCCONNELL MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2013
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 49 LAKE AVE LOWR LEVEL3
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City | GREENWICH
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State | CT
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Zip | 06830-4501
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Country | US
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Telephone | 203-900-4226
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Fax | 731-201-5307
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Provider Business Mailing Address
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Address Line | 49 LAKE AVE LOWR LEVEL3
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City | GREENWICH
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State | CT
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Zip | 06830-4501
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Country | US
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Telephone |
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 2019-00380
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 331848
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 79508
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License Number State | CT
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