Individual
PHILIP J O'DONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
104 SELMA DR, WINCHESTER, VA 22601-3834
(540) 678-2800
Mailing address
104 SELMA DR, WINCHESTER, VA 22601-3834
(540) 678-2800
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
0101028422
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006071813
—
VA
05
—
0083655000
—
WV
01
—
014333
ANTHEM BCBS
VA
01
—
08240900000
SOUTHERN HEALTH COVENTRY
VA
01
—
3119593
MAMSI
VA
01
—
44245
SENTARA
VA
01
—
502802
NCPPO
VA
01
—
541003042003
MOUNTAIN STATE BCBS
WV
05
—
7551711 00
—
MD
01
—
9318661
MEDICARE GROUP
WV
01
—
C00075
MEDICARE GROUP
VA
Enumeration date
05/23/2005
Last updated
03/31/2021
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