Provider Demographics
NPI:1225000219
Name:O'LEARY, ALICE M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:M
Last Name:O'LEARY
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 1:2 ESSEX CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2926
Mailing Address - Country:US
Mailing Address - Phone:978-977-4300
Mailing Address - Fax:978-977-4313
Practice Address - Street 1:2 ESSEX CENTER DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2926
Practice Address - Country:US
Practice Address - Phone:978-977-4300
Practice Address - Fax:978-977-4313
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205182208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
J23476OtherBS
205182OtherTU
AA11451Medicare UPIN
MAA31769Medicare ID - Type Unspecified