Provider Demographics
NPI:1083649180
Name:CONNELLY, MAUREEN T (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:T
Last Name:CONNELLY
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 1:72 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3104
Mailing Address - Country:US
Mailing Address - Phone:617-432-1106
Mailing Address - Fax:
Practice Address - Street 1:HARVARD MEDICAL SCHOOL
Practice Address - Street 2:25 SHATTUCK ST. RM 206
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-432-1106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine