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General NPI Number Information
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NPI Number | 1851812218
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Entity Type | Individual
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Provider Name | MICHAEL CHARLES O'CONNOR JR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 11 NEVINS ST SUITE 201
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City | BRIGHTON
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State | MA
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Zip | 02135
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Country | US
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Telephone | 617-779-6382
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Fax | 617-789-2307
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Provider Business Mailing Address
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Address Line | 960 MASSACHUSETTS AVE FL 2
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City | BOSTON
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State | MA
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Zip | 02118-2690
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 036.160359
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 1020222
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License Number State | MA
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