Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 0104001006 | VA |
NPI | 1790865285 |
---|---|
Provider Name | Dr. Philip Peter Connolly |
First Address | Alexandria, VA 22310-3227 |
Second Address | Alexandria, VA 22310-3227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 30/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
026990 | ANTHEM (01) | VA |
G01662S01 | (02) | VA |
G884 | CAREFIRST BC/BS (01) | VA |
U26019 | (02) | VA |