=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659310811
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYN R O'CONNOR MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2006
-----------------------------------------------------
Last Update Date | 04/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1946 TOWN PARK BLVD STE 130
-----------------------------------------------------
City | UNIONTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44685-8372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-344-7820
-----------------------------------------------------
Fax | 330-928-4320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4300 ALLEN RD STE 210
-----------------------------------------------------
City | STOW
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44224-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-344-7820
-----------------------------------------------------
Fax | 330-928-4320
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | MD046570L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------