Provider Demographics
NPI:1780661603
Name:OCONNELL, JAMES J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:OCONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:780 ALBANY ST
Mailing Address - Street 2:BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2524
Mailing Address - Country:US
Mailing Address - Phone:617-726-1818
Mailing Address - Fax:857-654-1093
Practice Address - Street 1:780 ALBANY ST
Practice Address - Street 2:BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2524
Practice Address - Country:US
Practice Address - Phone:617-726-1818
Practice Address - Fax:857-654-1093
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA53045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3000028Medicaid
MAJ04062OtherBCBS MA
MA053045OtherTUFTS HEALTH PLAN
MAJ04062OtherBCBS MA
MA3000028Medicaid