Provider Demographics
NPI:1346592862
Name:O'CONNELL, KATHLEEN MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARY
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 STONECROP LN
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2405
Mailing Address - Country:US
Mailing Address - Phone:203-761-1106
Mailing Address - Fax:203-803-9318
Practice Address - Street 1:9 STONECROP LN
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2405
Practice Address - Country:US
Practice Address - Phone:203-761-1106
Practice Address - Fax:203-803-9318
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030733207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism