Healthcare Provider Details

I. General information

NPI: 1891992152
Provider Name (Legal Business Name): MICHAEL LIAM O'BYRNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

100 PENN SQUARE EAST - NORTH TOWER WANAMAKER BLDG - 9TH FLOOR
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax: 215-590-2204
Mailing address:
  • Phone: 267-425-9232
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD439352
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: