Healthcare Provider Details

I. General information

NPI: 1992733927
Provider Name (Legal Business Name): TODD MCMICHAEL OBRIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CENTENNIAL DR SUITE 201 NEW ENGLAND ORTHOPEDIC SPECIALISTS
PEABODY MA
01960
US

IV. Provider business mailing address

4 CENTENNIAL DR SUITE 201
PEABODY MA
01960
US

V. Phone/Fax

Practice location:
  • Phone: 978-531-0800
  • Fax: 978-531-2929
Mailing address:
  • Phone: 978-531-0800
  • Fax: 978-531-2929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number222908
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: