Healthcare Provider Details

I. General information

NPI: 1609208321
Provider Name (Legal Business Name): ROBERT J OBRIEN JR MD AND ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HERRICK ST SUITE 3000
BEVERLY MA
01915-2757
US

IV. Provider business mailing address

955 MAIN ST SUITE G6
WINCHESTER MA
01890-1961
US

V. Phone/Fax

Practice location:
  • Phone: 781-729-4878
  • Fax: 781-729-5989
Mailing address:
  • Phone: 781-729-4878
  • Fax: 781-729-5989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number72781
License Number StateMA

VIII. Authorized Official

Name: ROBERT J OBRIEN JR.
Title or Position: PRESIDENT/PHYSICIAN
Credential: MD
Phone: 781-729-4878