Provider Demographics
NPI:1134171143
Name:MCCONNELL NORMAN, AMY C (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:MCCONNELL NORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:MCCONNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5855 BREMO RD
Mailing Address - Street 2:STE 403
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1930
Mailing Address - Country:US
Mailing Address - Phone:804-288-3079
Mailing Address - Fax:804-282-6159
Practice Address - Street 1:5855 BREMO RD
Practice Address - Street 2:STE 403
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1930
Practice Address - Country:US
Practice Address - Phone:804-288-3079
Practice Address - Fax:804-282-6159
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN
VA5875056Medicaid
H60689Medicare UPIN
VA5875056Medicaid