MEDICARE: DR. ROBERTA PAULINE 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	207R00000X	Internal Medicine Physician	420008375	VT

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	:	1902976533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTA PAULINE O'BRIEN MD

Provider Business Mailing Address
First Line	:	8 ACORN CIR
Second Line	:
City	:	ESSEX JCT
State	:	VT
Zip	:	05452-4705
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	87 MAIN ST
Second Line	:
City	:	ESSEX JCT
State	:	VT
Zip	:	05452-3234
Country	:	US
Telephone Number	:	802-847-8354
Fax Number	:	802-847-6575

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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