Provider Demographics
NPI:1063426351
Name:MCCONNELL, TIMOTHY B (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:B
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-354-3700
Mailing Address - Fax:513-354-3705
Practice Address - Street 1:8099 CORNELL RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2231
Practice Address - Country:US
Practice Address - Phone:513-357-3700
Practice Address - Fax:513-354-3705
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-080-0340M207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00068010OtherMEDICARE RAILROAD
OH2333068Medicaid
KY64-05308500Medicaid
OHH61641Medicare UPIN
OHMC4083024Medicare ID - Type Unspecified