Healthcare Provider Details

I. General information

NPI: 1043291875
Provider Name (Legal Business Name): MARY JANE O'NEILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HERRICK ST C/O SHARON HAYES, RADIOLOGY DEPT
BEVERLY MA
01915-1790
US

IV. Provider business mailing address

2527 CRANBERRY HIGHWAY ATTN: NANCI KARDOS-CARLL/PROVIDER RELATIONS DEPT.
WAREHAM MA
02571-1046
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-3000
  • Fax: 978-921-7011
Mailing address:
  • Phone: 800-841-5200
  • Fax: 508-273-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number154176
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number154176
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: