Provider Demographics
NPI:1205842184
Name:OCONNOR, TERENCE (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1236
Mailing Address - Country:US
Mailing Address - Phone:716-712-0490
Mailing Address - Fax:716-712-0615
Practice Address - Street 1:3075 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1236
Practice Address - Country:US
Practice Address - Phone:716-712-0490
Practice Address - Fax:716-712-0615
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1756061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01283292Medicaid
NYRA5966Medicare ID - Type Unspecified
NY01283292Medicaid