Provider Demographics
NPI:1275520926
Name:CONNOLLY, JOSEPH III (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:CONNOLLY
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4881 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WPAFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5529
Mailing Address - Country:US
Mailing Address - Phone:937-257-8718
Mailing Address - Fax:937-656-1347
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:WPAFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5529
Practice Address - Country:US
Practice Address - Phone:937-257-8718
Practice Address - Fax:937-656-1347
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP000015832083A0100X
AZ26142083A0100X
CA20A 58692084N0400X
NV5412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine