Provider Demographics
NPI:1639243900
Name:O'CONNELL, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD.
Mailing Address - Street 2:WEST PAVILION, 3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-662-2891
Mailing Address - Fax:215-662-6734
Practice Address - Street 1:3400 CIVIC CENTER BLVD.
Practice Address - Street 2:WEST PAVILION, 3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-662-2891
Practice Address - Fax:215-662-6734
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD008797E208800000X
NY252428-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000641614Medicaid
PA000641614Medicaid
PAC31810Medicare UPIN