Provider Demographics
NPI:1861400699
Name:O'CONNELL, PATRICK AUSTIN (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:AUSTIN
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 1:10208 CERNY ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7884
Mailing Address - Country:US
Mailing Address - Phone:919-538-4751
Mailing Address - Fax:
Practice Address - Street 1:10208 CERNY ST
Practice Address - Street 2:SUITE 308
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7884
Practice Address - Country:US
Practice Address - Phone:919-538-4751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BO8411388OtherDEA
NC2058018Medicare PIN