1164503058 NPI number — JEANNE E O'BRIEN M.D.

Table of content: JEANNE E O'BRIEN M.D. (NPI 1164503058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164503058 NPI number — JEANNE E O'BRIEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'BRIEN
Provider First Name:
JEANNE
Provider Middle Name:
E
Provider Name Prefix Text:
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:
1164503058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15001 SHADY GROVE RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-6352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-340-1188
Provider Business Mailing Address Fax Number:
301-340-1612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15001 SHADY GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-6352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-340-1188
Provider Business Practice Location Address Fax Number:
301-340-1612
Provider Enumeration Date:
10/18/2006

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: 207VE0102X , with the licence number:  D0064448 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207VE0102X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 199489 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 886940-01 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0906-0020 . This is a "CAREFIRST BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2147646 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260038 . This is a "KAISER PERMANENTE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1257626 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 756592 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 198489 . This is a "ANTHEM HEALTHKEEPERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2147646 . This is a "UNITEDHEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4161559 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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