Healthcare Provider Details

I. General information

NPI: 1295774487
Provider Name (Legal Business Name): WILLIAM J O'BRIEN III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3554 HULMEVILLE RD SUITE 103
BENSALEM PA
19020-4366
US

IV. Provider business mailing address

424 MILL ST
BRISTOL PA
19007-4813
US

V. Phone/Fax

Practice location:
  • Phone: 215-504-9255
  • Fax: 215-504-9260
Mailing address:
  • Phone: 215-826-8050
  • Fax: 215-826-8054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS008318L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: