Provider Demographics
NPI:1558367375
Name:CONNELL, DONALD G (CRNA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:G
Last Name:CONNELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:285 DAVIDSON AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4153
Mailing Address - Country:US
Mailing Address - Phone:732-271-1400
Mailing Address - Fax:732-271-3544
Practice Address - Street 1:3639 E VIEW DR
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2034
Practice Address - Country:US
Practice Address - Phone:610-428-1544
Practice Address - Fax:610-395-9336
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2016-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA027196367500000X
PARN-200304-L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11803004OtherCAQH
PA1402212OtherFIRST PRIORITY
PA0019682070001Medicaid
PA1402212OtherHIGHMARK
PA2090513000OtherIBC
PA50014781OtherCAPITAL ADVANTAGE
PA77539OtherGEISINGER
PA0019682070003Medicaid
PA7389432OtherAETNA
PA1545071OtherGATEWAY
PA1545071OtherGATEWAY
S48530Medicare UPIN
PA11803004OtherCAQH