Healthcare Provider Details

I. General information

NPI: 1548230931
Provider Name (Legal Business Name): ANNE MARIE O'CONNOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 HOSPITAL DR
ST JOHNSBURY VT
05819-9210
US

IV. Provider business mailing address

PO BOX 905
ST JOHNSBURY VT
05819-0905
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-7300
  • Fax: 802-748-7321
Mailing address:
  • Phone: 802-748-7300
  • Fax: 802-748-7321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number12548
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number042-0012740
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: