Provider Demographics
NPI:1265402515
Name:O'CONNELL, KILLIAN R (MD)
Entity type:Individual
Prefix:
First Name:KILLIAN
Middle Name:R
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6 UNIVERSITY DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2360
Mailing Address - Country:US
Mailing Address - Phone:413-549-9232
Mailing Address - Fax:413-549-9233
Practice Address - Street 1:6 UNIVERSITY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2360
Practice Address - Country:US
Practice Address - Phone:413-549-9232
Practice Address - Fax:413-549-9233
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA1500742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0004467259OtherAETNA
MA0000000020637OtherBMC HEALTHNET
MA29343OtherHEALTH NEW ENGLAND
MA623386OtherTUFTS HEALTH PLAN
MAA21011OtherBLUE CROSS AND BLUE SHIEL
MA29343OtherHEALTH NEW ENGLAND
MA623386OtherTUFTS HEALTH PLAN