Provider Demographics
NPI:1437470481
Name:O'NEILL, ADRIENNE MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:MARIE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:ADRIENNE
Other - Middle Name:MARIE
Other - Last Name:COSTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1000 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2404
Mailing Address - Country:US
Mailing Address - Phone:937-493-4659
Mailing Address - Fax:937-492-6557
Practice Address - Street 1:1000 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2404
Practice Address - Country:US
Practice Address - Phone:937-493-4659
Practice Address - Fax:937-492-6557
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH59.000277213EP1101X
OH36.003604213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine