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NPI Code Detail

MEDICARE: DR. GERARD STEPHEN O'CONNOR M.D.

MEDICARE: DR. GERARD STEPHEN O'CONNOR M.D.
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
1174400000XSpecialistD0030368MD
2207Q00000XFamily Medicine PhysicianD0030368MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1KBH8OTHERMDMD BLUE CROSS GROUP #
2W251OTHERDCCAREFIRST GROUP #
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
439849601OTHERMDBLUE CROSS RENDERING #

General Provider Information

NPI Number : 1609879873
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GERARD STEPHEN O'CONNOR M.D.
Provider Business Mailing Address
First Line : 100 BROWN ST
Second Line :
City : CHESTERTOWN
State : MD
Zip : 21620-1435
Country : US
Telephone Number : 410-778-6303
Fax Number : 410-778-6306
Provider Business Practice Location Address
First Line : 100 BROWN ST
Second Line :
City : CHESTERTOWN
State : MD
Zip : 21620-1435
Country : US
Telephone Number : 410-778-6303
Fax Number : 410-778-6306
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 06/05/2023

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