1447346531 NPI number — DANIEL O'LEARY M.D.

Table of content: DANIEL O'LEARY M.D. (NPI 1447346531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447346531 NPI number — DANIEL O'LEARY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'LEARY
Provider First Name:
DANIEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1447346531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 MEMORIAL DRIVE
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
LEOMINSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-534-4242
Provider Business Mailing Address Fax Number:
978-534-3705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MEMORIAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
LEOMINSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-534-4241
Provider Business Practice Location Address Fax Number:
978-534-3705
Provider Enumeration Date:
10/05/2006

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: 207R00000X , with the licence number:  57335 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 057334 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3031683 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61796 . This is a "HARVARD PILGIRM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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