Healthcare Provider Details

I. General information

NPI: 1447217054
Provider Name (Legal Business Name): DANIEL LAWRENCE OBRIEN MPA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 SMYTH RD VAMC
MANCHESTER NH
03104-7004
US

IV. Provider business mailing address

718 SMYTH RD VAMC
MANCHESTER NH
03104-7004
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-4366
  • Fax:
Mailing address:
  • Phone: 603-624-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number425
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: