Healthcare Provider Details

I. General information

NPI: 1235152430
Provider Name (Legal Business Name): DONALD J OCONNOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 GALLOWS ROAD NORTHERN VA MENTAL HEALTH INSTITUTE
FALLS CHURCH VA
22042
US

IV. Provider business mailing address

2509 N KENILWORTH STREET
ARLINGTON VA
22207
US

V. Phone/Fax

Practice location:
  • Phone: 703-207-7100
  • Fax: 703-207-7401
Mailing address:
  • Phone: 703-237-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101042600
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: