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General NPI Number Information
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NPI Number | 1861516718
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Entity Type | Individual
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Provider Name | JEROME THOMAS O'CONNELL JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/18/2007
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 2300 OPITZ BLVD
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City | WOODBRIDGE
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State | VA
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Zip | 22191
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Country | US
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Telephone | 703-670-1835
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Fax | 703-670-0827
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Provider Business Mailing Address
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Address Line | 224-D CORNWALL STREET, NW, SUITE 403 DEPARTMENT OF PATHOLOGY
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City | LEESBURG
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State | VA
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Zip | 20176-2704
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Country | US
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Telephone | 703-737-6010
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Fax | 703-443-8643
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD32177
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | A63118
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | D0058140
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | 0101231713
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License Number State | VA
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