Healthcare Provider Details

I. General information

NPI: 1215969753
Provider Name (Legal Business Name): PATRICK M O'BEIRNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WOODLAND ST SUITE 35
HARTFORD CT
06105-2372
US

IV. Provider business mailing address

19 WOODLAND ST SUITE 35
HARTFORD CT
06105-2372
US

V. Phone/Fax

Practice location:
  • Phone: 860-525-1234
  • Fax: 860-278-8782
Mailing address:
  • Phone: 860-525-1234
  • Fax: 860-278-8782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number055154
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number055154
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: