Provider Demographics
NPI:1548205925
Name:O'LEARY, HELEN TERESA (MD)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:TERESA
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 MALLARD CREEK RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4194
Mailing Address - Country:US
Mailing Address - Phone:502-690-8782
Mailing Address - Fax:502-459-0923
Practice Address - Street 1:332 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2130
Practice Address - Country:US
Practice Address - Phone:502-583-0909
Practice Address - Fax:502-583-0913
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37773207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64067903Medicaid
A03145Medicare UPIN
KY0516852Medicare PIN