Healthcare Provider Details

I. General information

NPI: 1831275650
Provider Name (Legal Business Name): PATRICIA OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

40 WRIGHT CT
SOUTH BURLINGTON VT
05403-6521
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0420008014
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: