Provider Demographics
NPI:1336140136
Name:O'BRIEN, PATRICK K H (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:K H
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966B PARK ST # B
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3650
Mailing Address - Country:US
Mailing Address - Phone:781-344-4400
Mailing Address - Fax:781-344-6956
Practice Address - Street 1:966B PARK ST # B
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3650
Practice Address - Country:US
Practice Address - Phone:781-344-4400
Practice Address - Fax:781-344-6956
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156605208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0106691Medicaid
H25005Medicare UPIN
MAA31590Medicare ID - Type Unspecified
MAUX8946Medicare PIN