Provider Demographics
NPI:1629279567
Name:O'HARA, EDWARD F (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:F
Last Name:O'HARA
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:PO BOX 488
Mailing Address - Street 2:1009 RADIO ROAD
Mailing Address - City:TUCKERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-0488
Mailing Address - Country:US
Mailing Address - Phone:609-296-3540
Mailing Address - Fax:609-296-1783
Practice Address - Street 1:1009 RADIO RD
Practice Address - Street 2:
Practice Address - City:TUCKERTON
Practice Address - State:NJ
Practice Address - Zip Code:08087-1638
Practice Address - Country:US
Practice Address - Phone:609-296-3540
Practice Address - Fax:609-296-1783
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03815200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1203002Medicaid
NJOH197145Medicare ID - Type Unspecified
NJD96557Medicare UPIN