Provider Demographics
NPI:1861434607
Name:O'NEILL, DARREN STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:STEPHEN
Last Name:O'NEILL
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 1:2150 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-739-5676
Mailing Address - Fax:413-739-2278
Practice Address - Street 1:701 ENFIELD ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-2961
Practice Address - Country:US
Practice Address - Phone:860-741-6058
Practice Address - Fax:860-741-6864
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151285207R00000X
CT036429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA151285OtherTUFTS HEALTH PLAN
MAJ18564OtherBLUE CROSS BLUE SHIELD
MA24085OtherHEALTH NEW ENGLAND
CT010036429CT01OtherBLUE CROSS BLUE SHIELD
MA3176835Medicaid
MA3176835Medicaid
MAJ18564OtherBLUE CROSS BLUE SHIELD