Provider Demographics
NPI:1366454621
Name:O'BRIEN, GRAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAEL
Middle Name:
Last Name:O'BRIEN
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 1:131 COVENTRY ST
Mailing Address - Street 2:BURGDORF CLINIC - 2ND FLOOR ADMINISTRATION
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1548
Mailing Address - Country:US
Mailing Address - Phone:860-714-3690
Mailing Address - Fax:860-714-8683
Practice Address - Street 1:131 COVENTRY ST
Practice Address - Street 2:BURGDORF CLINIC - 2ND FLOOR ADMINISTRATION
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1548
Practice Address - Country:US
Practice Address - Phone:860-714-3690
Practice Address - Fax:860-714-8683
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0398872080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001398876-CLMedicaid
CT10453102OtherCAQH