Provider Demographics
NPI:1215904818
Name:MCCONNELL, PATRICK VERNE (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:VERNE
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 OLEANDER DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4766
Mailing Address - Country:US
Mailing Address - Phone:910-772-2092
Mailing Address - Fax:910-772-2093
Practice Address - Street 1:5710 OLEANDER DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4766
Practice Address - Country:US
Practice Address - Phone:910-772-2092
Practice Address - Fax:910-772-2093
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104190363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S96511Medicare UPIN
NCPA16906Medicare PIN
NC2770121EMedicare PIN
NC2770121AMedicare PIN
S96511Medicare UPIN