Provider Demographics
NPI:1134118458
Name:ODONNELL, NANCY J (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 NAZARETH RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2017
Mailing Address - Country:US
Mailing Address - Phone:610-559-7880
Mailing Address - Fax:610-559-0633
Practice Address - Street 1:3311 NAZARETH RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2017
Practice Address - Country:US
Practice Address - Phone:610-559-7880
Practice Address - Fax:610-559-0633
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033621E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03057100OtherB CROSS
PA147920OtherB SHIELD
B39800Medicare UPIN
PA147920Medicare ID - Type Unspecified