Organization
LEO P O'CONNELL MD PC
Active
Other names
BREAST DIAGNOSTIC CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TINA HARRIS (MEDICAL BILLING CLERK)
(757) 595-8650
Entity
Organization
Contact information
Practice address
704 THIMBLE SHOALS BLVD, SUITE 600B, NEWPORT NEWS, VA 23606-4544
(757) 595-8650
(757) 591-8651
Mailing address
704 THIMBLE SHOALS BLVD, SUITE 600B, NEWPORT NEWS, VA 23606-4544
(757) 595-8650
(757) 591-8651
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101024069
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196140
ANTHEM BCBS
VA
01
—
630000723
MEDICARE RAILROAD
VA
05
—
7243481
—
VA
Enumeration date
03/21/2007
Last updated
06/21/2018
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