Provider Demographics
NPI:1235105057
Name:MCCONNELL, JENNIFER J (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:READFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04355-0310
Mailing Address - Country:US
Mailing Address - Phone:207-620-4449
Mailing Address - Fax:207-685-3035
Practice Address - Street 1:169 SOUTH RD
Practice Address - Street 2:
Practice Address - City:READFIELD
Practice Address - State:ME
Practice Address - Zip Code:04355-3340
Practice Address - Country:US
Practice Address - Phone:207-620-4449
Practice Address - Fax:207-685-3208
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME300470099Medicaid
MEBX7985Medicare PIN
ME080100805Medicare PIN
MEG54896Medicare UPIN
MEMM679001Medicare PIN
ME300470099Medicaid
ME080121884Medicare PIN