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NPI Code Detail

MEDICARE: DR. MARK D O'BRIEN D.O.

MEDICARE: DR. MARK D O'BRIEN D.O.
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
1208000000XPediatrics Physician02001451AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000606296OTHERINANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265532212
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK D O'BRIEN D.O.
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6507 E STATE BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-7026
Country : US
Telephone Number : 260-486-3300
Fax Number : 260-486-3600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2006
Last Update Date : 04/14/2025

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Directions to “ DR. MARK D O'BRIEN D.O.” Practice Location

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