Provider Demographics
NPI:1285211821
Name:ODONNELL, BRIAN J
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:ODONNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 DOUGLASS RD
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1449
Mailing Address - Country:US
Mailing Address - Phone:215-565-5958
Mailing Address - Fax:
Practice Address - Street 1:46 DOUGLASS RD
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1449
Practice Address - Country:US
Practice Address - Phone:215-565-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty