Provider Demographics
NPI:1346201225
Name:CONNOR, KRISSIE (DO)
Entity Type:Individual
Prefix:
First Name:KRISSIE
Middle Name:
Last Name:CONNOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-595-2505
Mailing Address - Fax:508-385-4065
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-595-2505
Practice Address - Fax:508-854-0650
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7537566OtherAETNA US HEALTHCARE
110239905OtherRAILROAD MEDICARE
AA1261OtherHARVARD PILGRIM HEALTHCAR
MA0181200Medicaid
0403700OtherEVERCARE
042472266008OtherTRICARE CHAMPUS
2118599OtherFIRST HEALTH
54949OtherFALLON COMMUNITY HEALTH P
8134337OtherCIGNA HEALTH PLAN
0181200OtherWELFARE
J25230OtherBLUE SHIELD INDEMNITY
784013OtherMVP HEALTH CARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
J25230OtherBLUE CARE ELECT
J25230OtherBLUE SHIELD HMO BLUE
A34437OtherMEDICARE B
042472266OtherONE HEALTH PLAN
042472266OtherTHREE RIVERS
2118599OtherFIRST HEALTH
MA0181200Medicaid