1023974425 NPI number — EDWARD OHARA MD

Table of content: JILL MARIE BERG M.P.T (NPI 1447366158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023974425 NPI number — EDWARD OHARA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD OHARA MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1023974425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 FOREST AVE STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95128-1422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-673-4077
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 FOREST AVE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95128-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-673-4077
Provider Business Practice Location Address Fax Number:
510-443-7934
Provider Enumeration Date:
12/29/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OHARA
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
510-299-9239

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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