Provider Demographics
NPI:1700858438
Name:O'BRIEN, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1085 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:670 ALBANY ST
Practice Address - Street 2:FLOOR 3, ROOM 310
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2646
Practice Address - Country:US
Practice Address - Phone:617-414-5314
Practice Address - Fax:617-414-5315
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA40684207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30204395Medicaid
MA6169813Medicaid
MA6169813Medicaid
MAJ1004801Medicare PIN