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General NPI Number Information
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NPI Number | 1972726495
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Entity Type | Individual
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Provider Name | MARK MADDOX O'BRIEN M.D. , M.P.H.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6 HARRINGTON RD
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City | CRANSTON
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State | RI
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Zip | 02920-3080
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Country | US
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Telephone | 401-462-2760
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Fax | 401-462-2757
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Provider Business Mailing Address
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Address Line | 6 HARRINGTON RD
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City | CRANSTON
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State | RI
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Zip | 02920-3080
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Country | US
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Telephone | 401-462-2760
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Fax | 401-462-2757
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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 | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | MD05818
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License Number State | RI
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