Provider Demographics
NPI:1093791444
Name:CONNAUGHTON, JOANNE T (MD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:T
Last Name:CONNAUGHTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:T
Other - Last Name:STOREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5525 RESEARCH PARK DR FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:610-387-4520
Mailing Address - Fax:610-387-4526
Practice Address - Street 1:1553 CHESTER PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:CRUM LYNNE
Practice Address - State:PA
Practice Address - Zip Code:19022-1022
Practice Address - Country:US
Practice Address - Phone:610-499-7180
Practice Address - Fax:610-876-0859
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043655E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011846190005Medicaid
PAE27378Medicare UPIN
PA0011846190005Medicaid