Healthcare Provider Details

I. General information

NPI: 1326233511
Provider Name (Legal Business Name): JAMES K OBRIEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 N BROAD ST
NORWICH NY
13815-1019
US

IV. Provider business mailing address

179 N BROAD ST
NORWICH NY
13815-1019
US

V. Phone/Fax

Practice location:
  • Phone: 607-337-4215
  • Fax: 607-337-4102
Mailing address:
  • Phone: 607-337-4215
  • Fax: 607-337-4102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number8121
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number168234
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: