Provider Demographics
NPI:1649249806
Name:O'CONNOR, JOHN J (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 SUMNEYTOWN PIKE STE 210
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5390
Mailing Address - Country:US
Mailing Address - Phone:215-257-5071
Mailing Address - Fax:215-257-1801
Practice Address - Street 1:817 LAWN AVE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1579
Practice Address - Country:US
Practice Address - Phone:215-257-5071
Practice Address - Fax:215-257-4378
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008988L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07705099Medicaid
PA177389GGEMedicare ID - Type Unspecified
PA07705099Medicaid