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Individual

MICHAEL M. HENNELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
3998 RED LION RD, EMERGENCY DEPARTMENT, PHILADELPHIA, PA 19114-1436
(215) 612-4000
(215) 807-8235
Mailing address
PO BOX 8500-6335, PHILADELPHIA, PA 19178-0001
(215) 807-8000
(215) 807-8235

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS010405L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00190010010003
PA
05
0019010010001
PA
05
0019010010002
PA
01
01901001-01
AMERICHOICE- TORRES
PA
01
01901001-02
AMERICHOICE- FRANKFORD
PA
01
01901001-03
AMERICHOICE- BUCKS
PA
01
07645
HEALTH PARTNERS
PA
01
1027108
CIGNA
PA
01
1164798
KEYSTONE MERCY
PA
01
1399033
HIGHMARK BLUE SHIELD
PA
01
20045133
AMERIHEALTH MERCY
PA
01
2087612000
KEYSTONE IBC
PA
01
452729
AETNA CONTRACT
PA
Enumeration date
07/19/2006
Last updated
07/12/2007
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