Provider Demographics
NPI:1518959865
Name:O'CONNELL, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
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 1:334 THOMAS MORE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3464
Mailing Address - Country:US
Mailing Address - Phone:859-341-0288
Mailing Address - Fax:859-344-7482
Practice Address - Street 1:2900 CHANCELLOR DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5427
Practice Address - Country:US
Practice Address - Phone:859-341-0288
Practice Address - Fax:859-344-7482
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
872928OtherAETNA
KY64330558Medicaid
021036000OtherFEDERAL BLACK LUNG
0404223OtherUNITED HEALTHCARE
000000044596OtherANTHEM
OH2466479Medicaid
310674100OtherUS DEPT OF LABOR
50006692OtherPASSPORT
KYP00935617OtherRAIL ROAD MEDICARE
KY64330558Medicaid
50006692OtherPASSPORT
KY110158251Medicare PIN
KYP400041789Medicare PIN
G60935Medicare UPIN
OH2466479Medicaid
KY0655008Medicare PIN
KY0399008Medicare PIN