Provider Demographics
NPI:1659310811
Name:O'CONNOR, CAROLYN R (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:R
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4300 ALLEN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1032
Mailing Address - Country:US
Mailing Address - Phone:330-344-7820
Mailing Address - Fax:330-928-4320
Practice Address - Street 1:1946 TOWN PARK BLVD STE 130
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8372
Practice Address - Country:US
Practice Address - Phone:330-344-7820
Practice Address - Fax:330-928-4320
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD046570L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001850996Medicaid
PA048854Medicare PIN
PAD19485Medicare UPIN