Provider Demographics
NPI:1497700298
Name:O'GRADY, SEAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:T
Last Name:O'GRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 CASSIDY DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-8393
Mailing Address - Country:US
Mailing Address - Phone:507-289-9236
Mailing Address - Fax:
Practice Address - Street 1:2110 E CENTER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4754
Practice Address - Country:US
Practice Address - Phone:507-287-0674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39400207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG54894Medicare UPIN