Healthcare Provider Details

I. General information

NPI: 1609879873
Provider Name (Legal Business Name): GERARD STEPHEN O'CONNOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BROWN ST
CHESTERTOWN MD
21620-1435
US

IV. Provider business mailing address

100 BROWN ST
CHESTERTOWN MD
21620-1435
US

V. Phone/Fax

Practice location:
  • Phone: 410-778-6303
  • Fax: 410-778-6306
Mailing address:
  • Phone: 410-778-6303
  • Fax: 410-778-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0030368
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0030368
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: