1821097304 NPI number — DR. BARBARA L OBRIEN M.D.

Table of content: DR. BARBARA L OBRIEN M.D. (NPI 1821097304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821097304 NPI number — DR. BARBARA L OBRIEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBRIEN
Provider First Name:
BARBARA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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 Information

NPI Number:
1821097304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
661 WASHINGTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRHOPE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36532-3119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-990-6443
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 GARFIELD AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-5312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-424-4330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2005

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: 207RG0100X , with the licence number:  12816 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100015928 . This is a "RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 7878382 . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009976530 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051512469 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 2900070 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C73817 . This is a "HEALTHSPRING" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051513984 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 721383260 . This is a "TRICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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