Provider Demographics
NPI:1295826618
Name:O'CONNELL, THOMAS P (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
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 1:108 S ALCANIZ ST
Mailing Address - Street 2:#206
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-6157
Mailing Address - Country:US
Mailing Address - Phone:850-974-4221
Mailing Address - Fax:
Practice Address - Street 1:108 S ALCANIZ ST
Practice Address - Street 2:#206
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6157
Practice Address - Country:US
Practice Address - Phone:850-974-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150667207L00000X
FLME89336207L00000X
VA0101237040207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010226201Medicaid
VA139230OtherTRIGON
VAP00265735OtherRAILROAD MEDICARE
VAK142-0001OtherCAREFIRST 2005
VA010165288Medicaid
VA484645OtherNCPPO
VAK142-0001OtherCAREFIRST 2005
VA010165288Medicaid
VA007816F81Medicare ID - Type Unspecified