1992994693 NPI number — GERARD S. O'CONNOR,M.D.

Table of content: (NPI 1992994693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992994693 NPI number — GERARD S. O'CONNOR,M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERARD S. O'CONNOR,M.D.
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:
1992994693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 BROWN ST STE 214
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTERTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21620-1435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-778-6303
Provider Business Mailing Address Fax Number:
410-778-6306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BROWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21620-1435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-778-6303
Provider Business Practice Location Address Fax Number:
410-778-6306
Provider Enumeration Date:
10/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
O'CONNOR
Authorized Official First Name:
GERARD
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
410-778-6303

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D0030368 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 507L . This is a "MEDICARE LEGACY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 39849601 . This is a "CAREFIRST RENDERING ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: W2510001 . This is a "CAREFIRST RENDERING ID" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com