Provider Demographics
NPI:1205855780
Name:O'BRIEN, KATHERINE
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64551
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4551
Mailing Address - Country:US
Mailing Address - Phone:410-328-3343
Mailing Address - Fax:410-328-3379
Practice Address - Street 1:7556 TEAGUE RD
Practice Address - Street 2:SUITE 430
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1213
Practice Address - Country:US
Practice Address - Phone:410-553-8260
Practice Address - Fax:410-553-8261
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR131471176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407152200Medicare ID - Type Unspecified
MDQ45171Medicare UPIN