Provider Demographics
NPI:1518427004
Name:MCCONNELL, DANIEL JAMES (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:MCCONNELL
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:ONE GUSTAVE LEVY PLACE, BOX 1620
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-824-8069
Mailing Address - Fax:
Practice Address - Street 1:1743 SIDEWINDER DRIVE
Practice Address - Street 2:UNIT 114
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060
Practice Address - Country:US
Practice Address - Phone:307-840-9834
Practice Address - Fax:833-450-0933
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY321493-01207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program