1932182292 NPI number — DEBORAH M O HARA PA C

Table of content: DEBORAH M O HARA PA C (NPI 1932182292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932182292 NPI number — DEBORAH M O HARA PA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O HARA
Provider First Name:
DEBORAH
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA C
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:
1932182292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2014
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:
CENTRAL VERMONT MEDICAL CENTER - 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:
802-485-4161
Provider Business Mailing Address Fax Number:
802-485-4163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 CRESCENT AVE
Provider Second Line Business Practice Location Address:
GREEN MOUNTAIN FAMILY PRACTICE
Provider Business Practice Location Address City Name:
NORTHFIELD
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05663-5704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-485-4161
Provider Business Practice Location Address Fax Number:
802-485-4163
Provider Enumeration Date:
11/21/2005

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: 207Q00000X , with the licence number:  0550030353 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 055.0030933 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 90002631 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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