MEDICARE: DR. CAROLYN BETH 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	D62445	MD
2	207R00000X	Internal Medicine Physician	MD463445	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1457419491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN BETH O'CONNOR MD

Provider Business Mailing Address
First Line	:	401 ROUTE 73 N BLDG 10, SUITE 320
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053
Country	:	US
Telephone Number	:	267-405-3330
Fax Number	:	856-762-1775

Provider Business Practice Location Address
First Line	:	794 PENLLYN BLUE BELL PIKE STE 218
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-1669
Country	:	US
Telephone Number	:	267-405-3330
Fax Number	:

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	08/25/2023

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