Provider Demographics
NPI:1538126123
Name:O'DONNELL, PHILIP H (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:H
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1490 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-8670
Mailing Address - Country:US
Mailing Address - Phone:419-782-6588
Mailing Address - Fax:419-784-3622
Practice Address - Street 1:1490 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-8670
Practice Address - Country:US
Practice Address - Phone:419-782-6588
Practice Address - Fax:419-784-3622
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2023-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35063310207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0889409Medicaid
OH0889409Medicaid
OHF27527Medicare UPIN