Provider Demographics
NPI:1417932542
Name:O'CONNELL, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:O'CONNELL
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 1:69 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3049
Mailing Address - Country:US
Mailing Address - Phone:413-586-8156
Mailing Address - Fax:
Practice Address - Street 1:69 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3049
Practice Address - Country:US
Practice Address - Phone:413-586-8156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1533672084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA111105OtherHARVARD PILGRIM
MA3676690OtherAETNA
MAJ14723OtherBCBSMA
MA23890OtherBMC
MA403137OtherTUFTS
MA153367OtherCONNECTICARE
MA7404242OtherCIGNA
MA20119OtherHEALTH NEW ENGLAND
MA9734350Medicaid
A22165Medicare ID - Type Unspecified
MAJ14723OtherBCBSMA