Healthcare Provider Details

I. General information

NPI: 1215257100
Provider Name (Legal Business Name): MICHAEL ROBERT O'BRIEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N HENDERSON RD STE 310
KING OF PRUSSIA PA
19406-2155
US

IV. Provider business mailing address

28 SADDLEBROOK LN
PHOENIXVILLE PA
19460-2393
US

V. Phone/Fax

Practice location:
  • Phone: 610-801-1805
  • Fax:
Mailing address:
  • Phone: 631-255-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD482644
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60273132
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: