Provider Demographics
NPI:1346621737
Name:SUSQUEHANNA ORTHOPAEDIC ASSOCIATES JOHN P O'HEARN MD LLC
Entity Type:Organization
Organization Name:SUSQUEHANNA ORTHOPAEDIC ASSOCIATES JOHN P O'HEARN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-879-9636
Mailing Address - Street 1:2 COLGATE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2624
Mailing Address - Country:US
Mailing Address - Phone:410-879-9636
Mailing Address - Fax:410-879-0376
Practice Address - Street 1:2 COLGATE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2624
Practice Address - Country:US
Practice Address - Phone:410-879-9636
Practice Address - Fax:410-879-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM06162261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center