Healthcare Provider Details

I. General information

NPI: 1538377882
Provider Name (Legal Business Name): MR. MICHAEL KEVIN O'HARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 BALTIMORE RD NW
LANCASTER OH
43130-8212
US

IV. Provider business mailing address

212 S MAIN ST P.O. BOX 64
SUGAR GROVE OH
43155-0064
US

V. Phone/Fax

Practice location:
  • Phone: 740-681-5655
  • Fax:
Mailing address:
  • Phone: 740-503-5637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: