Provider Demographics
NPI:1346261120
Name:CONNELLY, JOSEPH V (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:V
Last Name:CONNELLY
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 1:1351 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2419
Mailing Address - Country:US
Mailing Address - Phone:203-621-3822
Mailing Address - Fax:203-621-3711
Practice Address - Street 1:1351 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2419
Practice Address - Country:US
Practice Address - Phone:203-621-3822
Practice Address - Fax:203-621-3711
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTTINOtherOXFORD
CT694351OtherAETNA
CTTINOtherFIRST HEALTH
CTTINOtherMULTIPLAN
CT004243367Medicaid
CT026272OtherCONNECTICARE
CT0V5753OtherHEALTH NET
CT687961OtherEMPIRE BC/BS
CTTINOtherPOMCO
CTP1315104OtherOXFORD HEALTH PLAN
CTTINOtherPRIVATE HEALTHCARE SYSTEM
CTTINOtherNEHCA HMC/PPO
CTTINOtherFOCUS
CT010026272CT01OtherANTHEM BC/BS
CT7043443OtherCIGNA
CTTINOtherPOMCO
CTTINOtherPRIVATE HEALTHCARE SYSTEM