Healthcare Provider Details

I. General information

NPI: 1245485572
Provider Name (Legal Business Name): JAMES C O'BRIEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 NORTH ST BERKSHIRE FACULTY SERVICES - NEUROSURGERY AT BHS
PITTSFIELD MA
01201-4147
US

IV. Provider business mailing address

725 NORTH ST
PITTSFIELD MA
01201-4109
US

V. Phone/Fax

Practice location:
  • Phone: 413-447-2870
  • Fax: 413-447-2871
Mailing address:
  • Phone: 413-881-5427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number892
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: