Provider Demographics
NPI:1114939980
Name:O'CONNELL, KATHY EDWINA (MD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:EDWINA
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11842 ROCK LANDING DR STE 115
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4437
Mailing Address - Country:US
Mailing Address - Phone:757-505-9905
Mailing Address - Fax:757-595-5377
Practice Address - Street 1:11842 ROCK LANDING DR STE 115
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4437
Practice Address - Country:US
Practice Address - Phone:757-505-9905
Practice Address - Fax:757-595-5377
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101048159207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA160001342Medicare PIN