Provider Demographics
NPI:1912960428
Name:CONNOR, MARYANN (DO)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:CONNOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 LIMESTONE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5408
Mailing Address - Country:US
Mailing Address - Phone:302-998-1151
Mailing Address - Fax:302-998-1154
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5408
Practice Address - Country:US
Practice Address - Phone:302-998-1151
Practice Address - Fax:302-998-1154
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0005062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000834703Medicaid
DE001880V95Medicare ID - Type Unspecified
DE0000834703Medicaid