Provider Demographics
NPI:1306810635
Name:O'CONNELL, JUDITH ANN (DO)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2510 COMMONS BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3820
Mailing Address - Country:US
Mailing Address - Phone:937-429-8620
Mailing Address - Fax:937-429-8629
Practice Address - Street 1:2510 COMMONS BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3820
Practice Address - Country:US
Practice Address - Phone:937-429-8620
Practice Address - Fax:937-429-8629
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34003222204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0509524Medicaid
OHOC0515067Medicare Oscar/Certification
OHE00678Medicare UPIN