Provider Demographics
NPI:1619969987
Name:MCCONNELL, JEFFREY R (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:1250 S CEDAR CREST BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6224
Practice Address - Country:US
Practice Address - Phone:610-402-8900
Practice Address - Fax:610-402-5656
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036203E207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0729687000OtherKEYSTONE EAST
PA78711OtherGEISINGER
PA200046150OtherRAILROAD MEDICARE
PA0962542OtherCIGNA
PA478769OtherBLUE SHIELD
PA821246OtherFIRST PRIORITY HEALTH
PAP2949827OtherOXFORD
PA478769OtherKEYSTONE CENTRAL
PA0019478600004Medicaid
PA4357330OtherAETNA
PA478769OtherAMERIHEALTH ADMIN
PA50010433OtherBLUE CROSS
PA4357330OtherAETNA
PA50010433OtherBLUE CROSS