Healthcare Provider Details

I. General information

NPI: 1235459561
Provider Name (Legal Business Name): ANNE MARIE O'CONNOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

IV. Provider business mailing address

528 WASHINGTON HWY
MORRISVILLE VT
05661-8973
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-2381
  • Fax:
Mailing address:
  • Phone: 802-888-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD28437
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number17586
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD76112
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0420015010
License Number StateVT
# 5
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberMD28437
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: