JOHN ELDRIDGE CONNOLLY MD
NPI 1104516145
Student in an Organized Health Care Education/Training Program in Philadelphia, PA
About John Eldridge Connolly Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JOHN ELDRIDGE CONNOLLY MD (NPI 1104516145) is an individual student in an organized health care education/training program in Philadelphia, Pennsylvania and active in the NPI registry since May 2023. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
John Eldridge Connolly Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
PHILADELPHIA, PA 19104
PHILADELPHIA, PA 19104
PHILADELPHIA, PA 19104
PHILADELPHIA, PA 19104
PHILADELPHIA, PA 19104
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is John Connolly's NPI number?
The NPI number for John Connolly is 1104516145. It was assigned to this individual provider in the NPPES registry on May 12, 2023.
Where is John Connolly located?
John Connolly practices at 3400 Civic Center Blvd, Philadelphia, PA 19104. The listed phone number is (215) 662-3990.
What is John Connolly's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is John Connolly enrolled in Medicare?
Yes. John Connolly is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for John Connolly was last updated on August 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# John Eldridge Connolly, MD · NPI 1104516145
Student in an Organized Health Care Education/Training Program provider in Philadelphia, Pennsylvania. Individual provider, active in the CMS NPPES registry since May 12, 2023.
## Identity
- **NPI:** 1104516145 (Entity type: Individual)
- **Enumerated:** May 12, 2023
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** No
## Practice location
- **Address:** 3400 CIVIC CENTER BLVD, Philadelphia, PA 19104-5127
- **Phone:** (215) 662-3990
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** August 10, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1104516145) · Data from the CMS NPPES public registry.