Healthcare Provider Details

I. General information

NPI: 1679981864
Provider Name (Legal Business Name): MEABH O'HARE MB BCH BAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 FENWOOD RD
BOSTON MA
02115-6128
US

IV. Provider business mailing address

60 FENWOOD RD
BOSTON MA
02115-6128
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-7432
  • Fax:
Mailing address:
  • Phone: 617-732-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number282994
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number282994
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number282994
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: