Provider Demographics
NPI:1114956752
Name:O'CONNOR, MAEVE E (MD)
Entity Type:Individual
Prefix:
First Name:MAEVE
Middle Name:E
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 ELIZABETH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2534
Mailing Address - Country:US
Mailing Address - Phone:704-910-1402
Mailing Address - Fax:704-910-1506
Practice Address - Street 1:1523 ELIZABETH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2534
Practice Address - Country:US
Practice Address - Phone:704-910-1402
Practice Address - Fax:704-910-1506
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20030857207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913444Medicaid
NC01284OtherBCBS
SCNOO857Medicaid
NCB833Medicare PIN
NC01284OtherBCBS
H14771Medicare UPIN
SCNOO857Medicaid