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NPI Code Detail

MEDICARE: THOMAS JAMES CONNOLLY M.D.

MEDICARE:   THOMAS JAMES CONNOLLY  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianA35990CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194739946
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS JAMES CONNOLLY M.D.
Provider Business Mailing Address
First Line : PO BOX 9602
Second Line :
City : MISSION HILLS
State : CA
Zip : 91346-9602
Country : US
Telephone Number : 818-837-5691
Fax Number : 818-792-4793
Provider Business Practice Location Address
First Line : 27924 SECO CANYON RD
Second Line :
City : SANTA CLARITA
State : CA
Zip : 91350-3870
Country : US
Telephone Number : 661-513-2100
Fax Number : 661-513-2156
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 03/26/2014

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Directions to “ THOMAS JAMES CONNOLLY M.D.” Practice Location

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