Provider Demographics
NPI:1134113889
Name:CONNOLLY, PATRICK J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 MADISON AVENUE
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-2901
Mailing Address - Country:US
Mailing Address - Phone:609-832-5060
Mailing Address - Fax:
Practice Address - Street 1:217 MADISON AVENUE
Practice Address - Street 2:PENN MEDICINE VIRTUA MT. HOLLY NEUROSURGERY
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2901
Practice Address - Country:US
Practice Address - Phone:215-829-6700
Practice Address - Fax:215-829-6700
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430407207T00000X
NJ25MA08681400207T00000X, 207T00000X
IN01051049A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
042341OtherSIHO
000000338521OtherANTHEM
NJ178411Medicaid
PA102222412Medicaid
I00209Medicare UPIN
PA138054YFQ1Medicare PIN
042341OtherSIHO