Provider Demographics
NPI:1114928280
Name:MCCONVILLE, OWEN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:ROBERT
Last Name:MCCONVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 POND PARK RD.
Mailing Address - Street 2:STE. 102
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4309
Mailing Address - Country:US
Mailing Address - Phone:781-337-5555
Mailing Address - Fax:781-331-0300
Practice Address - Street 1:2 POND PARK RD.
Practice Address - Street 2:STE. 102
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4309
Practice Address - Country:US
Practice Address - Phone:781-337-5555
Practice Address - Fax:781-331-0300
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA57979207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
106348OtherBLUE SHIELD
MA3026604Medicaid
B20457701OtherCIGNA HEALTH CARE
057979OtherTUFTS HEALTH PLAN
341179OtherONE HEALTH
171347OtherHARVARD PILGRIM HEALTH
900078OtherUNITED HEALTH CARE
106348OtherBLUE SHIELD
341179OtherONE HEALTH