Provider Demographics
NPI:1255320347
Name:O'CONNELL, LUKE M (MD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:M
Last Name:O'CONNELL
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 1:780 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1622
Mailing Address - Country:US
Mailing Address - Phone:781-331-4600
Mailing Address - Fax:781-337-5095
Practice Address - Street 1:780 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1622
Practice Address - Country:US
Practice Address - Phone:781-331-4600
Practice Address - Fax:781-337-5095
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209714174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0027079OtherNEIGHBORHOOD HEALTH PLAN
MA7032336OtherUS HEALTHCARE
MA9718672Medicaid
MA5384955001OtherCIGNA
MD1900416OtherUNITED HEALTHCARE
MA273197OtherHARVARD PILGRIM
MA209714OtherTUFTS
MA55439OtherFALLON
MAJ24900OtherBLUE SHIELD
MA5384955001OtherCIGNA