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General NPI Number Information
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NPI Number | 1104808138
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Entity Type | Individual
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Provider Name | AUSTIN JOHN O'BRIEN MD
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Gender | Male
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 595 PAWTUCKET BLVD. 2ND FL 2ND FLOOR
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City | LOWELL
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State | MA
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Zip | 01852
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Country | US
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Telephone | 978-459-8447
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Fax | 978-459-6125
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Provider Business Mailing Address
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Address Line | 595 PAWTUCKET BLVD 2ND FLOOR
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City | LOWELL
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State | MA
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Zip | 01854-2042
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Country | US
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Telephone | 978-459-8447
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Fax | 978-459-6125
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 76888
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License Number State | MA
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