Provider Demographics
NPI:1639129976
Name:CONNELL, JOANNE E (MD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:E
Last Name:CONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 829641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0001
Mailing Address - Country:US
Mailing Address - Phone:267-370-5296
Mailing Address - Fax:215-230-3725
Practice Address - Street 1:1456 FERRY ROAD
Practice Address - Street 2:SUITE 600
Practice Address - City:FOUNTAINVILLE
Practice Address - State:PA
Practice Address - Zip Code:18923
Practice Address - Country:US
Practice Address - Phone:215-230-8390
Practice Address - Fax:215-230-8392
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD-426360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30214739OtherKEYSTONE FIRST
PAP01193476OtherRAILROAD MEDICARE
PAP011848OtherGATEWAY
PA1013521720002Medicaid
PA1745073OtherHIGHMARK BLUE SHIELD
PA2410648000OtherKEYSTONE IBC
PA7525732OtherAETNA
PA9699888OtherCIGNA
PA9699888OtherCIGNA
PAI40290Medicare UPIN