MEDICARE: DR. DORENE ANNE O'HARA 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	207L00000X	Anesthesiology Physician	048518	NJ
2	261QA1903X	Ambulatory Surgical Clinic/Center	0101240686	VA

General Provider Information

NPI Number	:	1679656607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DORENE ANNE O'HARA MD

Provider Business Mailing Address
First Line	:	1734 SEAGULL CT
Second Line	:	APT. 402
City	:	RESTON
State	:	VA
Zip	:	20194-4307
Country	:	US
Telephone Number	:	732-423-8533
Fax Number	:	571-313-0523

Provider Business Practice Location Address
First Line	:	1734 SEAGULL CT
Second Line	:	APT. 402
City	:	RESTON
State	:	VA
Zip	:	20194-4307
Country	:	US
Telephone Number	:	732-423-8533
Fax Number	:	571-313-0523

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	09/16/2013

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