Provider Demographics
NPI:1588802722
Name:MARY BRIGID CONNOLLY, MD, INC.
Entity Type:Organization
Organization Name:MARY BRIGID CONNOLLY, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BRIGID
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-797-3077
Mailing Address - Street 1:6812 N ORACLE RD
Mailing Address - Street 2:#100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4246
Mailing Address - Country:US
Mailing Address - Phone:520-797-3077
Mailing Address - Fax:520-742-0050
Practice Address - Street 1:6812 N ORACLE RD
Practice Address - Street 2:#100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4246
Practice Address - Country:US
Practice Address - Phone:520-797-3077
Practice Address - Fax:520-742-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ170812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ321555Medicaid
AZ321555Medicaid