Healthcare Provider Details

I. General information

NPI: 1124095997
Provider Name (Legal Business Name): TIMOTHY P O'CONNOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST VERNON CANCER CENTER
NEWTON MA
02462-1607
US

IV. Provider business mailing address

2014 WASHINGTON ST VERNON CANCER CENTER
NEWTON MA
02462-1607
US

V. Phone/Fax

Practice location:
  • Phone: 617-658-6000
  • Fax: 617-658-6001
Mailing address:
  • Phone: 617-658-6000
  • Fax: 617-658-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number36076
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: