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General NPI Number Information
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NPI Number | 1952426470
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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 | 03/21/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 704 THIMBLE SHOALS BLVD SUITE 600B
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4544
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Country | US
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Telephone | 757-595-8650
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Fax | 757-591-8651
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Provider Business Mailing Address
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Address Line | 704 THIMBLE SHOALS BLVD SUITE 600B
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4544
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Country | US
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Telephone | 757-595-8650
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Fax | 757-591-8651
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Authorized Official
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Title or Position | MEDICAL BILLING CLERK
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Name | MS. TINA HARRIS
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Credential |
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Telephone | 757-595-8650
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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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