Provider Demographics
NPI:1831158930
Name:O'NEIL, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:O'NEIL
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 1:1317 WOLF ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2934
Mailing Address - Country:US
Mailing Address - Phone:215-755-5449
Mailing Address - Fax:215-755-0010
Practice Address - Street 1:1317 WOLF ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2934
Practice Address - Country:US
Practice Address - Phone:215-755-5449
Practice Address - Fax:215-755-0010
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07305100207RC0000X
PAMD435484207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2K4965OtherHEALTHNET
NJ0016039Medicaid
0007893458OtherAETNA
P3008701OtherOXFORD
NJH46822Medicare UPIN
2K4965OtherHEALTHNET
P00024581Medicare PIN
NJ050475AW3Medicare PIN
NJ050475ZHBRMedicare PIN