Provider Demographics
NPI:1063440121
Name:O'CONNELL, ELLEN J (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:J
Last Name:O'CONNELL
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 1:4034 RAWLINS ST APT 106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5632
Mailing Address - Country:US
Mailing Address - Phone:214-252-0490
Mailing Address - Fax:
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3629
Practice Address - Country:US
Practice Address - Phone:972-420-1576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9831207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C0848OtherBCBS
TXP00399314OtherRAILROAD
TXI31134Medicare UPIN
TX8G4016Medicare ID - Type Unspecified