Provider Demographics
NPI:1881745461
Name:CONNOLLY, MAUREEN ANNE (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANNE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 TOWNCREST DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6622
Mailing Address - Country:US
Mailing Address - Phone:319-338-7862
Mailing Address - Fax:319-338-2517
Practice Address - Street 1:2460 TOWNCREST DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6622
Practice Address - Country:US
Practice Address - Phone:319-338-7862
Practice Address - Fax:319-338-2517
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0745877Medicaid
IA32308OtherWELLMARK
IA32308OtherWELLMARK
IA0745877Medicaid