Provider Demographics
NPI:1245318245
Name:MCCONNELL, ROSANNA CAROL (MD)
Entity type:Individual
Prefix:
First Name:ROSANNA
Middle Name:CAROL
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSANNA
Other - Middle Name:CAROL
Other - Last Name:MCCONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 W WENDOVER AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408
Mailing Address - Country:US
Mailing Address - Phone:336-333-9111
Mailing Address - Fax:336-333-2042
Practice Address - Street 1:1305 W WENDOVER AVE
Practice Address - Street 2:SUITE D
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-333-9111
Practice Address - Fax:336-333-2042
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901492207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134VAMedicaid
P00041373OtherRR MEDICARE
NC134VAOtherBCBS
P00041373OtherRR MEDICARE
H88204Medicare UPIN