Individual
THOMAS O'CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2900 CHANCELLOR DR, CRESTVIEW HILLS, KY 41017-5427
(859) 341-0288
(859) 344-7482
Mailing address
334 THOMAS MORE PKWY, SUITE 200, CRESTVIEW HILLS, KY 41017-3464
(859) 341-0288
(859) 344-7482
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
33055
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000044596
ANTHEM
—
01
—
021036000
FEDERAL BLACK LUNG
—
01
—
0404223
UNITED HEALTHCARE
—
05
—
2466479
—
OH
01
—
310674100
US DEPT OF LABOR
—
01
—
50006692
PASSPORT
—
05
—
64330558
—
KY
01
—
872928
AETNA
—
01
—
P00935617
RAIL ROAD MEDICARE
KY
Enumeration date
08/22/2005
Last updated
08/01/2011
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