Provider Demographics
NPI:1871596924
Name:O'DONNELL, PHILIP J (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:O'DONNELL
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 1:104 SELMA DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3834
Mailing Address - Country:US
Mailing Address - Phone:540-678-2800
Mailing Address - Fax:
Practice Address - Street 1:104 SELMA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3834
Practice Address - Country:US
Practice Address - Phone:540-678-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028422207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3119593OtherMAMSI
VA006071813Medicaid
WV0083655000Medicaid
VA08240900000OtherSOUTHERN HEALTH COVENTRY
VA502802OtherNCPPO
WV9318661OtherMEDICARE GROUP
VAC00075OtherMEDICARE GROUP
WV541003042003OtherMOUNTAIN STATE BCBS
VA014333OtherANTHEM BCBS
VA44245OtherSENTARA
MD7551711 00Medicaid