Provider Demographics
NPI:1285783787
Name:O'CONNELL, RUARY CILIAN (MD)
Entity type:Individual
Prefix:DR
First Name:RUARY
Middle Name:CILIAN
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-4255
Mailing Address - Country:US
Mailing Address - Phone:504-899-8907
Mailing Address - Fax:504-897-0714
Practice Address - Street 1:101 E FAIRWAY DR
Practice Address - Street 2:SUITE 402
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7503
Practice Address - Country:US
Practice Address - Phone:985-892-8959
Practice Address - Fax:985-892-8975
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013995208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1182079Medicaid
B61086Medicare UPIN
LA1182079Medicaid