Provider Demographics
NPI:1942370226
Name:OCONNELL, TIMOTHY ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ANDREW
Last Name:OCONNELL
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 1:12706 MCMANUS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4460
Mailing Address - Country:US
Mailing Address - Phone:757-874-2229
Mailing Address - Fax:757-874-7525
Practice Address - Street 1:12706 MCMANUS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4460
Practice Address - Country:US
Practice Address - Phone:757-874-2229
Practice Address - Fax:757-874-7525
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035509207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160001512Medicare PIN