Provider Demographics
NPI:1265214290
Name:CONNELLY, OWEN DANIEL (MD)
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:DANIEL
Last Name:CONNELLY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 CALLE LOPEZ LANDRON APT 304
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-2189
Mailing Address - Country:US
Mailing Address - Phone:787-507-2957
Mailing Address - Fax:
Practice Address - Street 1:1554 CALLE LOPEZ LANDRON APT 304
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-2189
Practice Address - Country:US
Practice Address - Phone:787-507-2957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program