Provider Demographics
NPI:1073667010
Name:VINCENT J. O'BRIEN JR. MD, INC
Entity Type:Organization
Organization Name:VINCENT J. O'BRIEN JR. MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-529-1440
Mailing Address - Street 1:14601 DETROIT AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4251
Mailing Address - Country:US
Mailing Address - Phone:216-529-1440
Mailing Address - Fax:216-529-8432
Practice Address - Street 1:14601 DETROIT AVE STE 450
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4251
Practice Address - Country:US
Practice Address - Phone:216-529-1440
Practice Address - Fax:216-529-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty