Provider Demographics
NPI:1952393761
Name:MCCONNELL, ELIZABETH J (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:MCCONNELL
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:PO BOX 5458
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5400
Mailing Address - Country:US
Mailing Address - Phone:602-253-4271
Mailing Address - Fax:602-253-4273
Practice Address - Street 1:6245 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-1706
Practice Address - Country:US
Practice Address - Phone:602-253-4271
Practice Address - Fax:602-253-4273
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ28532208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ526874Medicaid
AZZ111891Medicare PIN
AZZ131733Medicare PIN
AZG52489Medicare UPIN