Provider Demographics
NPI:1235135625
Name:MCRILL, CONNIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:M
Last Name:MCRILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1001 PINE HEIGHTS AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5266
Mailing Address - Country:US
Mailing Address - Phone:410-644-9515
Mailing Address - Fax:410-644-8250
Practice Address - Street 1:1001 PINE HEIGHTS AVE
Practice Address - Street 2:STE 101
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5266
Practice Address - Country:US
Practice Address - Phone:410-644-9515
Practice Address - Fax:410-644-8250
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0052935207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD875500100Medicaid
MD2035241OtherAETNA
MD259627OtherMAMSI
MD5322-0005OtherBLUE CHOICE
MD072L031VMedicare PIN
MD2035241OtherAETNA
MDG64284Medicare UPIN