Provider Demographics
NPI:1114970183
Name:O'HARA, KATHLEEN PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:PATRICIA
Last Name:O'HARA
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 1:211 ESSEX ST
Mailing Address - Street 2:#206
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3231
Mailing Address - Country:US
Mailing Address - Phone:201-996-0087
Mailing Address - Fax:201-996-0185
Practice Address - Street 1:211 ESSEX ST
Practice Address - Street 2:#206
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3231
Practice Address - Country:US
Practice Address - Phone:201-996-0087
Practice Address - Fax:201-996-0185
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66138174400000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001212Medicare ID - Type Unspecified
NJG58106Medicare UPIN