Provider Demographics
NPI:1245432467
Name:CONNELL, NATHAN THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:THEODORE
Last Name:CONNELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:HEMATOLOGY DIVISION MID-CAMPUS BLDG., SR332
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-5190
Mailing Address - Fax:617-732-5706
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:HEMATOLOGY DIVISION MID-CAMPUS BLDG., SR332
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-5190
Practice Address - Fax:617-732-5706
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD13347207R00000X
MA258434207RH0000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology