Provider Demographics
NPI:1679656607
Name:O'HARA, DORENE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DORENE
Middle Name:ANNE
Last Name:O'HARA
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 1:1734 SEAGULL CT
Mailing Address - Street 2:APT. 402
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-4307
Mailing Address - Country:US
Mailing Address - Phone:732-423-8533
Mailing Address - Fax:571-313-0523
Practice Address - Street 1:1734 SEAGULL CT
Practice Address - Street 2:APT. 402
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20194-4307
Practice Address - Country:US
Practice Address - Phone:732-423-8533
Practice Address - Fax:571-313-0523
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ048518207L00000X
VA0101240686261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology