Provider Demographics
NPI:1043291875
Name:O'NEILL, MARY JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2527 CRANBERRY HIGHWAY
Mailing Address - Street 2:ATTN: NANCI KARDOS-CARLL/PROVIDER RELATIONS DEPT.
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1046
Mailing Address - Country:US
Mailing Address - Phone:800-841-5200
Mailing Address - Fax:508-273-1241
Practice Address - Street 1:85 HERRICK ST
Practice Address - Street 2:C/O SHARON HAYES, RADIOLOGY DEPT
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1790
Practice Address - Country:US
Practice Address - Phone:978-922-3000
Practice Address - Fax:978-921-7011
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2012-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1541762085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA154176OtherTUFTS HEALTH PLAN
MAJ17687OtherBCBS MA
MA3166678Medicaid
G47132Medicare UPIN
MA3166678Medicaid