Provider Demographics
NPI:1972582476
Name:OCONNELL, KATHLEEN M (DPM PC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:DPM PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 WATERFRONT DR E
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1140
Mailing Address - Country:US
Mailing Address - Phone:412-461-1108
Mailing Address - Fax:412-461-5490
Practice Address - Street 1:640 RODI RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-4512
Practice Address - Country:US
Practice Address - Phone:412-731-5500
Practice Address - Fax:412-731-5548
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005681213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015190430001Medicaid
PA1033459425OtherNPI GROUP NUMBER
PAV08888Medicare UPIN
PA1015190430001Medicaid