Healthcare Provider Details

I. General information

NPI: 1811524887
Provider Name (Legal Business Name): EDMOND JOSEPH O'LEARY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 REID PKWY STE 200
RICHMOND IN
47374-1155
US

IV. Provider business mailing address

1100 REID PARKWAY PAYOR ENROLLMENT
RICHMOND IN
47374
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-3960
  • Fax: 765-935-8540
Mailing address:
  • Phone: 765-983-3000
  • Fax: 765-935-8592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number322272
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number322272
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number02007714A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: