Provider Demographics
NPI:1659632057
Name:O'CONNOR, PATRICIA W (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:W
Last Name:O'CONNOR
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 1:201 CONCOURSE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5640
Mailing Address - Country:US
Mailing Address - Phone:804-939-6186
Mailing Address - Fax:804-549-4032
Practice Address - Street 1:201 CONCOURSE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5640
Practice Address - Country:US
Practice Address - Phone:804-549-4040
Practice Address - Fax:804-549-4032
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101266970207N00000X
ALMD.34947207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology