Provider Demographics
NPI:1801830617
Name:MACCONNELL, PATRICK ARNOLD (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ARNOLD
Last Name:MACCONNELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18834-6603
Mailing Address - Country:US
Mailing Address - Phone:570-456-4500
Mailing Address - Fax:570-465-4501
Practice Address - Street 1:433 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18834-6603
Practice Address - Country:US
Practice Address - Phone:570-456-4500
Practice Address - Fax:570-465-4501
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABM2828929213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0036341Medicaid
PA149430Medicare ID - Type Unspecified
PA0036341Medicaid