Provider Demographics
NPI:1104399427
Name:MCDONNELL, JOSEPH J
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:MCDONNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 W MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5604
Mailing Address - Country:US
Mailing Address - Phone:419-222-1527
Mailing Address - Fax:419-222-3586
Practice Address - Street 1:658 W MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5604
Practice Address - Country:US
Practice Address - Phone:419-222-1527
Practice Address - Fax:419-222-3586
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator