Healthcare Provider Details

I. General information

NPI: 1427211341
Provider Name (Legal Business Name): MEGHAN OBRIEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 ERICSSON PL
NEW YORK NY
10013-2411
US

IV. Provider business mailing address

32 ERICSSON PL
NEW YORK NY
10013-2411
US

V. Phone/Fax

Practice location:
  • Phone: 212-374-9750
  • Fax: 212-374-9705
Mailing address:
  • Phone: 212-374-9750
  • Fax: 212-374-9705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number257622
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: