Healthcare Provider Details

I. General information

NPI: 1215980313
Provider Name (Legal Business Name): GERALD M O'BRIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD SUITE 220
NEWARK DE
19713-2067
US

IV. Provider business mailing address

4745 OGLETOWN STANTON RD SUITE 220
NEWARK DE
19713-2067
US

V. Phone/Fax

Practice location:
  • Phone: 302-368-5515
  • Fax: 302-366-1240
Mailing address:
  • Phone: 302-368-5515
  • Fax: 302-366-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC10006061
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: