Healthcare Provider Details

I. General information

NPI: 1316892276
Provider Name (Legal Business Name): ROBERT O'CONNOR PA-C, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST
BOSTON MA
02111-1552
US

IV. Provider business mailing address

14 WARD ST APT 206
SOMERVILLE MA
02143-4264
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA102068
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: