Provider Demographics
NPI:1942272315
Name:MCCONNELL, EDWARD J III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:MCCONNELL
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:111 CONTINENTAL DR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4306
Mailing Address - Country:US
Mailing Address - Phone:302-984-2577
Mailing Address - Fax:302-368-1271
Practice Address - Street 1:111 CONTINENTAL DR
Practice Address - Street 2:SUITE 406
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4306
Practice Address - Country:US
Practice Address - Phone:302-984-2577
Practice Address - Fax:302-368-1271
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2014-03-06
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0001782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
016934S36Medicare ID - Type Unspecified
DE130757ZAG8Medicare PIN
B66497Medicare UPIN