Provider Demographics
NPI:1487847844
Name:PAUL E OBRIEN MD INC
Entity Type:Organization
Organization Name:PAUL E OBRIEN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-434-3180
Mailing Address - Street 1:2717 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3797
Mailing Address - Country:US
Mailing Address - Phone:937-434-3180
Mailing Address - Fax:937-434-9807
Practice Address - Street 1:2717 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3797
Practice Address - Country:US
Practice Address - Phone:937-434-3180
Practice Address - Fax:937-434-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0408366Medicaid
OH=========-00OtherWORKERS COMPENSATION
C01715Medicare UPIN
OH0408366Medicaid