Provider Demographics
NPI:1205197597
Name:HUGH J CONNOLLY MD PA
Entity Type:Organization
Organization Name:HUGH J CONNOLLY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-251-3434
Mailing Address - Street 1:9000 SW 152ND ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1981
Mailing Address - Country:US
Mailing Address - Phone:305-251-3434
Mailing Address - Fax:305-971-6393
Practice Address - Street 1:9000 SW 152ND ST
Practice Address - Street 2:SUITE 107
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1981
Practice Address - Country:US
Practice Address - Phone:305-251-3434
Practice Address - Fax:305-971-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-03
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014984207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050276600Medicaid
FLD59608Medicare UPIN
FL91364AMedicare PIN