Healthcare Provider Details

I. General information

NPI: 1053379420
Provider Name (Legal Business Name): EDWARD P OBRIEN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTER RD
WEST SENECA NY
14224
US

IV. Provider business mailing address

300 CENTER RD
WEST SENECA NY
14224
US

V. Phone/Fax

Practice location:
  • Phone: 716-674-1001
  • Fax: 716-674-6345
Mailing address:
  • Phone: 716-674-1001
  • Fax: 716-674-6345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number229534
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number229534
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: