Provider Demographics
NPI:1447343363
Name:OCONNELL, DENNIS M (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:OCONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 BASICH BLVD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1066
Mailing Address - Country:US
Mailing Address - Phone:360-533-0400
Mailing Address - Fax:360-533-5633
Practice Address - Street 1:1108 BASICH BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1066
Practice Address - Country:US
Practice Address - Phone:360-533-0400
Practice Address - Fax:360-533-5633
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000205682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8552804Medicaid
B18249Medicare UPIN