MEDICARE: SEAN C O'BRIEN PA

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	363A00000X	Physician Assistant	055.0031197	VT
2	363AM0700X	Medical Physician Assistant	0895	NH

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	:	1508126681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN C O'BRIEN PA

Provider Business Mailing Address
First Line	:	PO BOX 547
Second Line	:	ATT: CVMC FINANCE DEPT
City	:	BARRE
State	:	VT
Zip	:	05641-0547
Country	:	US
Telephone Number	:	802-371-4239
Fax Number	:	802-371-4237

Provider Business Practice Location Address
First Line	:	1311 BARRE-MONTPELIER RD
Second Line	:	STE 200
City	:	BERLIN
State	:	VT
Zip	:	05602-0000
Country	:	US
Telephone Number	:	802-371-4239
Fax Number	:	802-371-4237

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

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	06/26/2015

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Directions to “ SEAN C O'BRIEN PA” Practice Location

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