Provider Demographics
NPI:1568455335
Name:O'CONNELL, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
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 1:9275 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7779
Mailing Address - Country:US
Mailing Address - Phone:513-936-4510
Mailing Address - Fax:513-936-4511
Practice Address - Street 1:9275 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7779
Practice Address - Country:US
Practice Address - Phone:513-936-4510
Practice Address - Fax:513-936-4511
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-082498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2430293Medicaid
KY64072218Medicaid
OH4189781Medicare PIN
KYP400042037Medicare Oscar/Certification
H94850Medicare UPIN