Provider Demographics
NPI:1124374400
Name:DR. BILL OBRIEN
Entity Type:Organization
Organization Name:DR. BILL OBRIEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:215-378-0351
Mailing Address - Street 1:49 ROLLING LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19055-1112
Mailing Address - Country:US
Mailing Address - Phone:215-378-0351
Mailing Address - Fax:
Practice Address - Street 1:49 ROLLING LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055-1112
Practice Address - Country:US
Practice Address - Phone:215-378-0351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008318L261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA720171TTAMedicare PIN