Healthcare Provider Details

I. General information

NPI: 1114956752
Provider Name (Legal Business Name): MAEVE E O'CONNOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 ELIZABETH AVE SUITE 200
CHARLOTTE NC
28204-2534
US

IV. Provider business mailing address

1523 ELIZABETH AVE SUITE 200
CHARLOTTE NC
28204-2534
US

V. Phone/Fax

Practice location:
  • Phone: 704-910-1402
  • Fax: 704-910-1506
Mailing address:
  • Phone: 704-910-1402
  • Fax: 704-910-1506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number20030857
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: