Provider Demographics
NPI:1326027012
Name:MCCONNELL, JAMES JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:MCCONNELL
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 1:365 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1008
Mailing Address - Country:US
Mailing Address - Phone:276-228-8951
Mailing Address - Fax:276-228-2019
Practice Address - Street 1:365 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1008
Practice Address - Country:US
Practice Address - Phone:276-228-8951
Practice Address - Fax:276-228-2019
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6081916Medicaid
VA111953513Medicare ID - Type Unspecified
VA6081916Medicaid