Provider Demographics
NPI:1598081630
Name:CONNOLLY, EVE ALISON (MD)
Entity Type:Individual
Prefix:DR
First Name:EVE
Middle Name:ALISON
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3841
Mailing Address - Country:US
Mailing Address - Phone:707-624-6891
Mailing Address - Fax:
Practice Address - Street 1:8701 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1066
Practice Address - Country:US
Practice Address - Phone:937-558-3300
Practice Address - Fax:937-558-3313
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.127558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0176991Medicaid
OHH473730Medicare PIN