Provider Demographics
NPI:1316027386
Name:CONNOLLY, JOHN EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:CONNOLLY
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Gender:M
Credentials:DPM
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Mailing Address - Street 1:WHITE RIVER JUNCTION VAMC
Mailing Address - Street 2:DESK 90 (112)
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05009-0001
Mailing Address - Country:US
Mailing Address - Phone:802-291-6290
Mailing Address - Fax:802-296-6329
Practice Address - Street 1:WHITE RIVER JUNCTION VAMC
Practice Address - Street 2:DESK 90 (112)
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05009-0001
Practice Address - Country:US
Practice Address - Phone:802-291-6290
Practice Address - Fax:802-296-6329
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH0238213E00000X
VT056-0000137213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist