Provider Demographics
NPI:1407078017
Name:BREITMAN-OCONOR, SARA LAURIE (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LAURIE
Last Name:BREITMAN-OCONOR
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 1:6525 NORTH CHARLES STREET
Mailing Address - Street 2:SUITE 134
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-828-4804
Mailing Address - Fax:
Practice Address - Street 1:6525 NORTH CHARLES STREET
Practice Address - Street 2:SUITE 134
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-828-4804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00339972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1797Medicare ID - Type Unspecified
E75417Medicare UPIN