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General NPI Number Information
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NPI Number | 1730173360
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Entity Type | Individual
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Provider Name | WALTER M O'BRIEN MD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 19415 DEERFIELD AVENUE, SUITE 112
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City | LEESBURG
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State | VA
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Zip | 20176-8470
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Country | US
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Telephone | 703-724-1195
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Fax | 703-724-4495
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Provider Business Mailing Address
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Address Line | 9815 SPRING RIDGE LN
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City | VIENNA
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State | VA
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Zip | 22182-1453
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Country | US
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Telephone |
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Fax |
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0101038671
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License Number State | VA
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