Healthcare Provider Details

I. General information

NPI: 1437136561
Provider Name (Legal Business Name): CHARLES E O'NEILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NORTH ST
PITTSFIELD MA
01201-4109
US

IV. Provider business mailing address

2 PARK STREET
PITTSFIELD MA
01201-4109
US

V. Phone/Fax

Practice location:
  • Phone: 413-881-5427
  • Fax: 413-496-6836
Mailing address:
  • Phone: 413-664-4343
  • Fax: 413-664-7320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number57398
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: