Provider Demographics
NPI:1447210182
Name:O'DONNELL, GERARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:J
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1139 CARTHAGE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4111
Mailing Address - Country:US
Mailing Address - Phone:919-774-2195
Mailing Address - Fax:919-776-8131
Practice Address - Street 1:1139 CARTHAGE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4111
Practice Address - Country:US
Practice Address - Phone:919-774-2195
Practice Address - Fax:919-776-8131
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC34424207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8963693Medicaid
NC63693OtherBCBS
NCE86899Medicare UPIN
NC63693OtherBCBS