Individual
DR. KEVIN J. CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
437 S MAIN ST, BRADFORD, VT 05033-8877
(802) 222-5562
Mailing address
P O BOX 318, BRADFORD, VT 05033-0338
(802) 222-5562
(802) 222-9276
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0420009101
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110105365
RAIL ROAD MEDICARE
VT
05
—
OVN1126
—
VT
Enumeration date
06/13/2006
Last updated
08/16/2010
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