Provider Demographics
NPI:1467431536
Name:O'HARA, MICHAEL WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:O'HARA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1641
Mailing Address - Country:US
Mailing Address - Phone:732-546-8113
Mailing Address - Fax:833-661-9952
Practice Address - Street 1:780 NJ ROUTE 37 WEST
Practice Address - Street 2:SUITE 330
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-0772
Practice Address - Country:US
Practice Address - Phone:732-780-2355
Practice Address - Fax:833-661-9952
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06250000207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ528019SL4OtherMEDICARE INDIVIDUAL PROVIDER NUMBER
NJF89396Medicare UPIN