MEDICARE: THOMAS O'CONNOR 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	207R00000X	Internal Medicine Physician	043720	CT
2	207R00000X	Internal Medicine Physician	ME134602	FL

General Provider Information

NPI Number	:	1437167434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS O'CONNOR MD

Provider Business Mailing Address
First Line	:	2151 E COMMERCIAL BLVD STE 302
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-3807
Country	:	US
Telephone Number	:	860-904-6779
Fax Number	:	860-904-6762

Provider Business Practice Location Address
First Line	:	2151 E COMMERCIAL BLVD STE 302
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-3807
Country	:	US
Telephone Number	:	860-904-6779
Fax Number	:	860-904-6762

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/26/2021

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Directions to “ THOMAS O'CONNOR MD” Practice Location

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