Provider Demographics
NPI:1518100247
Name:CONNELL, CLARA BETH (DO)
Entity Type:Individual
Prefix:MS
First Name:CLARA
Middle Name:BETH
Last Name:CONNELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:CLARA
Other - Middle Name:BETH
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:14955 SHADY GROVE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-990-3190
Mailing Address - Fax:
Practice Address - Street 1:14955 SHADY GROVE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8728
Practice Address - Country:US
Practice Address - Phone:301-990-3190
Practice Address - Fax:301-990-3199
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH77570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine