1578544557 NPI number — DR. PATRICIA JEAN OMALLEY MD

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	OMALLEY
Provider First Name	:	PATRICIA
Provider Middle Name	:	JEAN
Provider Name Prefix Text	:	DR.
Provider Name Suffix Text	:
Provider Credential Text	:	MD
Provider Gender Code	:	F

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Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
Provider Other Last Name Type Code	:

NPI Number	:	1578544557
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/08/2007
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
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Provider First Line Business Mailing Address	:	PO BOX 9142
Provider Second Line Business Mailing Address	:	MASS GENERAL PHYSICIAN ORGANIZATION
Provider Business Mailing Address City Name	:	CHARLESTOWN
Provider Business Mailing Address State Name	:	MA
Provider Business Mailing Address Postal Code	:	021299142
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	6177240287
Provider Business Mailing Address Fax Number	:	6177262894

Provider First Line Business Practice Location Address	:	55 FRUIT ST
Provider Second Line Business Practice Location Address	:	ELL 01 PEDIARIC EMERGENCY SERVICES
Provider Business Practice Location Address City Name	:	BOSTON
Provider Business Practice Location Address State Name	:	MA
Provider Business Practice Location Address Postal Code	:	021142696
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	6177244110
Provider Business Practice Location Address Fax Number	:	6177263231
Provider Enumeration Date	:	11/08/2005

Authorized Official Last Name	:
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• Taxonomy code: 207PP0204X , with the licence number:  42857 , registered in the state of MA .
• Taxonomy code: 208000000X , with the licence number: 42857 , registered in the state of MA .
• Taxonomy code: 2080P0203X , with the licence number: 42857 , registered in the state of MA .

• Identifier: 042857 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "".
• Identifier: 0128082 , issued by the state of ( MA ) . This identifiers is of the category "".
• Identifier: N01890 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "".
• Identifier: N01890 , issued by the state of ( MA ) . This identifiers is of the category "".
• Identifier: D88921 . This identifiers is of the category "".