Provider Demographics
NPI:1558145045
Name:OMEARA, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:OMEARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 ADAMS ST APT 310
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5767
Mailing Address - Country:US
Mailing Address - Phone:781-277-1747
Mailing Address - Fax:
Practice Address - Street 1:1241 ADAMS ST APT 310
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5767
Practice Address - Country:US
Practice Address - Phone:781-277-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2301870363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care