Individual
DR. KEVIN A. O'CONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 N MAIN ST, WARSAW, NY 14569-1025
(585) 786-1555
(585) 786-7983
Mailing address
400 N MAIN ST, WARSAW, NY 14569-1025
(585) 786-1555
(585) 786-7983
Taxonomy
Speciality
Code
Description
License number
State
207YX0602X
Otolaryngic Allergy Physician
041918
GA
207YX0602X
Otolaryngic Allergy Physician
Primary
191328
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000711301A
—
GA
01
—
040013774
RAIL ROAD MEDICARE
GA
01
—
191328
NYS MEDICAL LICENSE
NY
01
—
308584
WELLCARE
GA
01
—
584912
BLUE CROSS BLUE SHIELD
GA
Enumeration date
12/27/2007
Last updated
03/07/2023
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