MEDICARE: ROBERT J OBRIEN JR MD & ASSOC PC

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	207N00000X	Dermatology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M18384	OTHER	MA	BLUE CROSS

General Provider Information

NPI Number	:	1588646715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT J OBRIEN JR MD & ASSOC PC

Provider Business Mailing Address
First Line	:	955 MAIN ST
Second Line	:	SUITE G 6
City	:	WINCHESTER
State	:	MA
Zip	:	01890-1961
Country	:	US
Telephone Number	:	781-729-4878
Fax Number	:	781-729-5989

Provider Business Practice Location Address
First Line	:	955 MAIN ST
Second Line	:	SUITE G 6
City	:	WINCHESTER
State	:	MA
Zip	:	01890-1961
Country	:	US
Telephone Number	:	781-729-4878
Fax Number	:	781-729-5989

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT J OBRIEN JR.
Credential	:	MD
Telephone Number	:	781-729-4878

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	08/22/2020

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