MEDICARE: KRISTIN O'HARA

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	363AM0700X	Medical Physician Assistant	PA1439	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA5292	OTHER	MA	STATE LICENSE
2	PA1439	OTHER	ME	STATE OF MAINE

General Provider Information

NPI Number	:	1487075347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN O'HARA

Provider Business Mailing Address
First Line	:	98 DEERFOOT CIR
Second Line	:
City	:	MASHPEE
State	:	MA
Zip	:	02649-2440
Country	:	US
Telephone Number	:	508-801-3260
Fax Number	:

Provider Business Practice Location Address
First Line	:	489 BEARSES WAY
Second Line	:	UNIT A-4
City	:	HYANNIS
State	:	MA
Zip	:	02601-2707
Country	:	US
Telephone Number	:	508-771-4092
Fax Number	:	508-771-9466

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

Provider Enumeration Date	:	12/19/2013
Last Update Date	:	05/31/2026

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Directions to “ KRISTIN O'HARA ” Practice Location

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