Provider Demographics
NPI:1023031796
Name:CONNOLLY, THOMAS L (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 MERCY RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2372
Mailing Address - Country:US
Mailing Address - Phone:402-397-5236
Mailing Address - Fax:402-397-7849
Practice Address - Street 1:7710 MERCY RD
Practice Address - Street 2:SUITE 601
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2372
Practice Address - Country:US
Practice Address - Phone:402-397-5236
Practice Address - Fax:402-397-7849
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11049207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03553OtherBLUE CROSS BLUE SHIELD NE
NE261913COMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID
NED05069Medicare UPIN