MEDICARE: DR. CHRISTOPHER JOHN O'GRADY 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
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	G73458	CA

General Provider Information

NPI Number	:	1861474306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JOHN O'GRADY M.D.

Provider Business Mailing Address
First Line	:	65 NIELSON ST
Second Line	:	#104
City	:	WATSONVILLE
State	:	CA
Zip	:	95076-2491
Country	:	US
Telephone Number	:	831-786-8595
Fax Number	:	831-786-8557

Provider Business Practice Location Address
First Line	:	65 NIELSON ST
Second Line	:	#104
City	:	WATSONVILLE
State	:	CA
Zip	:	95076-2491
Country	:	US
Telephone Number	:	831-786-8595
Fax Number	:	831-786-8557

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/18/2024

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