Provider Demographics
NPI:1073802187
Name:O'CONNOR, BRENDAN C (MD)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:C
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3379 CHILI AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-5325
Mailing Address - Country:US
Mailing Address - Phone:585-889-0750
Mailing Address - Fax:585-889-0759
Practice Address - Street 1:3379 CHILI AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5325
Practice Address - Country:US
Practice Address - Phone:585-889-0750
Practice Address - Fax:585-889-0759
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY276607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03984952Medicaid
NY03984952Medicaid
NYJ400176278/GRP70008AMedicare PIN