Healthcare Provider Details

I. General information

NPI: 1669507141
Provider Name (Legal Business Name): THOMAS PATRICK O'CONNOR JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PERFORMANCE DR SUITE #110
WEYMOUTH MA
02189-3141
US

IV. Provider business mailing address

10 WILLARD ST
QUINCY MA
02169-1281
US

V. Phone/Fax

Practice location:
  • Phone: 781-337-9091
  • Fax:
Mailing address:
  • Phone: 617-479-1452
  • Fax: 617-479-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD035011
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number231774
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: