Provider Demographics
NPI:1356346423
Name:O'CONNELL, BRENT JAMES (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:JAMES
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1956 CHRISTOPHER PL
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3576
Mailing Address - Country:US
Mailing Address - Phone:717-302-2014
Mailing Address - Fax:717-302-2791
Practice Address - Street 1:1956 CHRISTOPHER PL
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3576
Practice Address - Country:US
Practice Address - Phone:717-302-2014
Practice Address - Fax:717-302-2791
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010197E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics