Provider Demographics
NPI:1922549146
Name:O'CONNOR, COLLEEN MARIE MCKENNA (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE MCKENNA
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1215 LEE STREET - BOX NUMBER 800710
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0001
Mailing Address - Country:US
Mailing Address - Phone:434-982-0629
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE STREET - BOX NUMBER 800710
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-1642
Practice Address - Country:US
Practice Address - Phone:434-982-0629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0095016207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program