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General NPI Number Information
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NPI Number | 1669501466
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Entity Type | Organization
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Legal Business Name | MARY T. O'BRIEN, MD, PLC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 422 COMMERCE RD
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City | STAUNTON
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State | VA
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Zip | 24401-4432
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Country | US
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Telephone | 540-886-6086
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Fax | 540-886-6918
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Provider Business Mailing Address
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Address Line | 422 COMMERCE RD
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City | STAUNTON
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State | VA
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Zip | 24401-4432
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Country | US
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Telephone | 540-886-6086
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Fax | 540-886-6918
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARY T. O'BRIEN
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Credential | M.D.
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Telephone | 540-886-6086
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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 | 0101017504
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License Number State | VA
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