1144302696 NPI number — MR. PATRICK FRANCIS DONNELLY CPO

Table of content: MR. PATRICK FRANCIS DONNELLY CPO (NPI 1144302696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144302696 NPI number — MR. PATRICK FRANCIS DONNELLY CPO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONNELLY
Provider First Name:
PATRICK
Provider Middle Name:
FRANCIS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CPO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOYCHAK
Provider Other First Name:
CARLA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
CERTIFIED FITTER
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1144302696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 BARNES RD STE 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALLINGFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06492-1832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-605-1725
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 BARNES RD STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLINGFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06492-1832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-605-1725
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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