Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 35.135688 | OH |
NPI | 1063438380 |
---|---|
Provider Name | Dr. Anne Maureen Connolly |
First Address | Columbus, OH 43205-2639 |
Second Address | Columbus, OH 43205-2664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 22/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0338775 | (05) | OH |
H703540 | CGS-MEDICARE (01) | OH |