MEDICARE: DR. TIMOTHY ADRIAN 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
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	L3267	TX
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	L3267	TX
3	207RP1001X	Pulmonary Disease Physician	L3267	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00316349	OTHER	TX	RAILROAD MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8R1145	OTHER	TX	BLUE CROSS OF TEXAS PROV#

General Provider Information

NPI Number	:	1396798153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY ADRIAN CONNOLLY M.D.

Provider Business Mailing Address
First Line	:	DEPT 794
Second Line	:	PO BOX 4346
City	:	HOUSTON
State	:	TX
Zip	:	77210-4346
Country	:	US
Telephone Number	:	713-255-4000
Fax Number	:	713-255-4050

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST STE 1632
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2734
Country	:	US
Telephone Number	:	713-255-4000
Fax Number	:	713-255-4050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	11/02/2023

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Directions to “ DR. TIMOTHY ADRIAN CONNOLLY M.D.” Practice Location

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