Provider Demographics
NPI:1083679021
Name:O'NEILL, DENNIS G (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:G
Last Name:O'NEILL
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:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06501-0206
Mailing Address - Country:US
Mailing Address - Phone:203-397-8000
Mailing Address - Fax:203-389-1540
Practice Address - Street 1:71 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:860-647-6487
Practice Address - Fax:860-647-6447
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023300207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001233006Medicaid
CTA524580OtherOXFORD
CTOR4388OtherHEALTHNET
CT008172967OtherAETNA/USHC
CTW1H29OtherEMPIRE BC/BS
CT500HBL161CT01OtherBLUE CROSS MMH
CT76164901OtherCONNECTICARE
CT0004300173OtherAETNA
CT1104296OtherUHC
CT0102330OtherCIGNA
CT500HBL161CT02OtherBLUE CROSS RGH
CTC009784OtherCHAMPUS TRICARE
CT76164901OtherCONNECTICARE
CTW1H29OtherEMPIRE BC/BS