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General NPI Number Information
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NPI Number | 1861577959
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Entity Type | Individual
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Provider Name | KATHLEEN B O'BRIEN MD
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 160 E ERIE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19134-1011
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Country | US
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Telephone | 215-427-3131
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Fax | 215-427-8782
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Provider Business Mailing Address
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Address Line | PO BOX 191 PROVIDER ENROLLMENT DEPT
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City | ROCKLAND
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State | DE
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Zip | 19732-0191
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Country | US
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Telephone | 302-651-6201
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Fax | 302-651-4945
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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 | 2080S0010X
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Taxonomy Name | Pediatric Sports Medicine Physician
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License Number | MD069374L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD069374L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | C10007503
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License Number State | DE
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Taxonomy #4
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Taxonomy Code | 2080S0010X
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Taxonomy Name | Pediatric Sports Medicine Physician
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License Number | C10007503
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License Number State | DE
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Taxonomy #5
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD069374L
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License Number State | PA
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