Provider Demographics
NPI:1760475644
Name:CONNELLY, RICHARD P (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 CALLE THEBE
Mailing Address - Street 2:PASEO DEL SOL
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4668
Mailing Address - Country:US
Mailing Address - Phone:787-278-1985
Mailing Address - Fax:
Practice Address - Street 1:221 CALLE THEBE
Practice Address - Street 2:PASEO DEL SOL
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4668
Practice Address - Country:US
Practice Address - Phone:787-278-1985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11498208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0089407Medicare ID - Type Unspecified
PRG66431Medicare UPIN