1508126681 NPI number — SEAN C O'BRIEN PA

Table of content: SEAN C O'BRIEN PA (NPI 1508126681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508126681 NPI number — SEAN C O'BRIEN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'BRIEN
Provider First Name:
SEAN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1508126681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 547
Provider Second Line Business Mailing Address:
ATT: CVMC FINANCE DEPT
Provider Business Mailing Address City Name:
BARRE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05641-0547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-371-4239
Provider Business Mailing Address Fax Number:
802-371-4237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1311 BARRE-MONTPELIER RD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05602-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-371-4239
Provider Business Practice Location Address Fax Number:
802-371-4237
Provider Enumeration Date:
05/22/2012

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: 363A00000X , with the licence number:  055.0031197 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: 0895 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9000735 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com