Provider Demographics
NPI:1649244500
Name:O'DONNELL, CLARE (MD)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 STILES RD
Mailing Address - Street 2:ATTN: SHARON SILVA
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2846
Mailing Address - Country:US
Mailing Address - Phone:603-893-9784
Mailing Address - Fax:603-893-8886
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6793
Practice Address - Fax:617-734-3157
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3128362080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA186449Medicaid
H73497Medicare UPIN
MAA34808Medicare ID - Type Unspecified