Provider Demographics
NPI:1942280300
Name:O'DONNELL, WARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:WARD
Middle Name:J
Last Name:O'DONNELL
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 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3457
Mailing Address - Country:US
Mailing Address - Phone:610-649-1515
Mailing Address - Fax:610-649-9564
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3448
Practice Address - Country:US
Practice Address - Phone:610-649-1515
Practice Address - Fax:610-649-9564
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043736L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001278822Medicaid
PA232359401OtherMAIN LINE HEALTHCARE
F22899Medicare UPIN
PA001278822Medicaid