Provider Demographics
NPI:1609879873
Name:O'CONNOR, GERARD STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:STEPHEN
Last Name:O'CONNOR
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 1:100 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1435
Mailing Address - Country:US
Mailing Address - Phone:410-778-6303
Mailing Address - Fax:410-778-6306
Practice Address - Street 1:100 BROWN ST
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1435
Practice Address - Country:US
Practice Address - Phone:410-778-6303
Practice Address - Fax:410-778-6306
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030368174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKBH8OtherMD BLUE CROSS GROUP #
DCW251OtherCAREFIRST GROUP #
MD390710400Medicaid
MD39849601OtherBLUE CROSS RENDERING #
DCW251OtherCAREFIRST GROUP #
MD390710400Medicaid