Basic Information
| Provider Information | |||||||||
| NPI: | 1619969987 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCONNELL | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 783311 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191783311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848844500 | ||||||||
| FaxNumber: | 4848840699 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 S CEDAR CREST BLVD STE 110 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104028900 | ||||||||
| FaxNumber: | 6104025656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 09/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD036203E | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | MD036203E | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 0729687000 | 01 | PA | KEYSTONE EAST | OTHER | 78711 | 01 | PA | GEISINGER | OTHER | 200046150 | 01 | PA | RAILROAD MEDICARE | OTHER | 0962542 | 01 | PA | CIGNA | OTHER | 478769 | 01 | PA | BLUE SHIELD | OTHER | 821246 | 01 | PA | FIRST PRIORITY HEALTH | OTHER | P2949827 | 01 | PA | OXFORD | OTHER | 478769 | 01 | PA | KEYSTONE CENTRAL | OTHER | 0019478600004 | 05 | PA | MEDICAID | 4357330 | 01 | PA | AETNA | OTHER | 478769 | 01 | PA | AMERIHEALTH ADMIN | OTHER | 50010433 | 01 | PA | BLUE CROSS | OTHER |