MEDICARE: DONALD G CONNELL CRNA

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	367500000X	Certified Registered Nurse Anesthetist	027196	PA
2	163W00000X	Registered Nurse	RN-200304-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11803004	OTHER	PA	CAQH
2	1402212	OTHER	PA	FIRST PRIORITY
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1402212	OTHER	PA	HIGHMARK
5	2090513000	OTHER	PA	IBC
6	50014781	OTHER	PA	CAPITAL ADVANTAGE
7	77539	OTHER	PA	GEISINGER
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	7389432	OTHER	PA	AETNA
10	1545071	OTHER	PA	GATEWAY

General Provider Information

NPI Number	:	1558367375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD G CONNELL CRNA

Provider Business Mailing Address
First Line	:	285 DAVIDSON AVE
Second Line	:	STE 204
City	:	SOMERSET
State	:	NJ
Zip	:	08873-4153
Country	:	US
Telephone Number	:	732-271-1400
Fax Number	:	732-271-3544

Provider Business Practice Location Address
First Line	:	3639 E VIEW DR
Second Line	:
City	:	OREFIELD
State	:	PA
Zip	:	18069-2034
Country	:	US
Telephone Number	:	610-428-1544
Fax Number	:	610-395-9336

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	04/22/2016

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