Provider Demographics
NPI:1013982867
Name:CONNELLY, JOHN E (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 N 17TH ST
Mailing Address - Street 2:SUITE #108
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5044
Mailing Address - Country:US
Mailing Address - Phone:610-954-6048
Mailing Address - Fax:610-954-3189
Practice Address - Street 1:501 N 17TH ST
Practice Address - Street 2:SUITE # 108
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5044
Practice Address - Country:US
Practice Address - Phone:610-434-4760
Practice Address - Fax:610-820-9122
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007130L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012679810004Medicaid
PAF09822Medicare UPIN
PA0012679810004Medicaid