MEDICARE: TIMOTHY D. O'BRIEN 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	208600000X	Surgery Physician	35076169	OH

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	:	1639136823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY D. O'BRIEN MD

Provider Business Mailing Address
First Line	:	PO BOX 228
Second Line	:
City	:	LOGAN
State	:	OH
Zip	:	43138-0228
Country	:	US
Telephone Number	:	740-380-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	819 STATE ROUTE 664 N STE B
Second Line	:
City	:	LOGAN
State	:	OH
Zip	:	43138-8540
Country	:	US
Telephone Number	:	740-380-8140
Fax Number	:	740-380-8150

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	11/23/2020

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