Basic Information
Provider Information
NPI: 1497173488
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CONNOLLY
FirstName: SEAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 191
Address2:  
City: ROCKLAND
State: DE
PostalCode: 197320191
CountryCode: US
TelephoneNumber: 3026514200
FaxNumber:  
Practice Location
Address1: 1600 ROCKLAND RD
Address2: SUITE 2B80
City: WILMINGTON
State: DE
PostalCode: 198033607
CountryCode: US
TelephoneNumber: 3026515874
FaxNumber: 3026515954
Other Information
ProviderEnumerationDate: 04/07/2014
LastUpdateDate: 05/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0202X25MB10924300NJY Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology

No ID Information.


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