MEDICARE: TIMOTHY O'HARE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	ME84166	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	040017000	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15346	OTHER	FL	BLUE CROSS BLUE SHIELD
2	198914	OTHER	FL	WELLCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2862947	OTHER	FL	AETNA
6	1356109001	OTHER	FL	CIGNA
7	7795340	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1154307676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY O'HARE MD

Provider Business Mailing Address
First Line	:	1344 S APOLLO BLVD
Second Line	:	STE 301
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3183
Country	:	US
Telephone Number	:	321-676-2353
Fax Number	:	321-951-9267

Provider Business Practice Location Address
First Line	:	1344 S APOLLO BLVD
Second Line	:	STE 301
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3183
Country	:	US
Telephone Number	:	321-676-2353
Fax Number	:	321-951-9267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	05/27/2008

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