Provider Demographics
NPI:1801839956
Name:ODONNELL, JOHN N (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:ODONNELL
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:PO BOX 3947
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89505-3947
Mailing Address - Country:US
Mailing Address - Phone:775-334-3450
Mailing Address - Fax:775-334-3417
Practice Address - Street 1:77 PRINGLE WAY
Practice Address - Street 2:WASHOE MEDICAL CENTER
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-334-3450
Practice Address - Fax:775-334-3417
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031889207ZP0102X
CAG25545207ZP0102X
NV3177207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXPY144570Medicaid
22WCGSZ1CMedicare ID - Type Unspecified
CAXPY144570Medicaid