Provider Demographics
NPI:1558365148
Name:O'CONNELL, MARK M (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1270 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2014
Mailing Address - Country:US
Mailing Address - Phone:732-615-3900
Mailing Address - Fax:732-671-0395
Practice Address - Street 1:111 LAWRENCEVILLE RD
Practice Address - Street 2:ADVANCED URGENT CARE OF LAWRENCEVILLE
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4307
Practice Address - Country:US
Practice Address - Phone:609-943-2071
Practice Address - Fax:609-943-2077
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06567600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8527903Medicaid
NJE99160Medicare UPIN
NJ8527903Medicaid