Provider Demographics
NPI:1104039197
Name:O'CONNELL, CASEY L (MD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:L
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-865-3105
Mailing Address - Fax:
Practice Address - Street 1:1441 EASTLAKE AVE
Practice Address - Street 2:NOR 8302E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0112
Practice Address - Country:US
Practice Address - Phone:323-865-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80627207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A806270197OtherCAL OPTIMA
CA00A806270OtherBLUE SHIELD
CAGR0100430OtherGROUP MEDICAL
CAW11675OtherGROUP MEDICARE PIN
CAW18762OtherGROUP MEDICARE
CA00A806270Medicaid
CA1356390009OtherGROUP NPI
CA1902846306OtherGROUP NPI
CA00A806270197OtherCAL OPTIMA
CACE1617OtherGROUP RAILROAD MEDICARE
CA1902846306OtherGROUP NPI