MEDICARE: DR. DANIEL MICHAEL O'CONNELL 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	208D00000X	General Practice Physician	MD.014835	LA
2	208D00000X	General Practice Physician	25MA08478500	NJ
3	208D00000X	General Practice Physician	MD435320	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F16075	OTHER	LA	UPIN

General Provider Information

NPI Number	:	1891017000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL MICHAEL O'CONNELL M.D.

Provider Business Mailing Address
First Line	:	714B WOLCOTT DR
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-4311
Country	:	US
Telephone Number	:	215-753-1969
Fax Number	:

Provider Business Practice Location Address
First Line	:	714B WOLCOTT DR
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-4311
Country	:	US
Telephone Number	:	215-753-1969
Fax Number	:

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

Provider Enumeration Date	:	02/16/2010
Last Update Date	:	02/16/2010

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