Provider Demographics
NPI:1699339739
Name:CONNELL, LAUREN ALEXANDRA (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALEXANDRA
Last Name:CONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ALEXANDRA
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14 TRAFALGAR SQ
Mailing Address - Street 2:
Mailing Address - City:TRAFALGAR
Mailing Address - State:IN
Mailing Address - Zip Code:46181-9515
Mailing Address - Country:US
Mailing Address - Phone:317-739-4895
Mailing Address - Fax:
Practice Address - Street 1:5550 S EAST ST STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1991
Practice Address - Country:US
Practice Address - Phone:317-534-4660
Practice Address - Fax:317-782-4301
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01088285A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program