Provider Demographics
NPI:1932291663
Name:MCCONNELL, CARMINE G (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMINE
Middle Name:G
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14308 HUGHES LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8502
Mailing Address - Country:US
Mailing Address - Phone:972-385-9388
Mailing Address - Fax:972-964-0281
Practice Address - Street 1:2301 COIT RD STE D
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-3773
Practice Address - Country:US
Practice Address - Phone:972-985-7100
Practice Address - Fax:972-964-0281
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG9495173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ0061654Medicare UPIN