Provider Demographics
NPI:1992094957
Name:GIDDINGS CONNOLLY, CHRISTOPHER A (MD)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:A
Last Name:GIDDINGS CONNOLLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:126 MARKET WAY
Practice Address - Street 2:
Practice Address - City:MT. POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344-3842
Practice Address - Country:US
Practice Address - Phone:570-839-3633
Practice Address - Fax:570-839-6490
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD457078207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106658OtherPROVIDER ID