Provider Demographics
NPI:1821315250
Name:O'CONNELL, EMILY (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BRAMBLE BUSH DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2325
Mailing Address - Country:US
Mailing Address - Phone:508-540-1801
Mailing Address - Fax:504-540-6595
Practice Address - Street 1:2 BRAMBLE BUSH DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2325
Practice Address - Country:US
Practice Address - Phone:508-540-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-25
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA254042208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty