Provider Demographics
NPI:1669795795
Name:EDWARD J. MCCONNELL MD INC.
Entity type:Organization
Organization Name:EDWARD J. MCCONNELL MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:302-993-0989
Mailing Address - Street 1:3 COURTNEY RD
Mailing Address - Street 2:SEDGELY FARMS
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2505
Mailing Address - Country:US
Mailing Address - Phone:302-993-0989
Mailing Address - Fax:
Practice Address - Street 1:3 COURTNEY RD
Practice Address - Street 2:SEDGELY FARMS
Practice Address - City:GREENVILLE
Practice Address - State:DE
Practice Address - Zip Code:19807-2505
Practice Address - Country:US
Practice Address - Phone:302-993-0989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0001782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE016934S36Medicare UPIN