Provider Demographics
NPI:1710033451
Name:O'MARA, SUSAN R (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:O'MARA
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 1:1000 RIVER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2439
Mailing Address - Country:US
Mailing Address - Phone:800-355-3818
Mailing Address - Fax:610-834-2862
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2976
Practice Address - Country:US
Practice Address - Phone:202-877-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD034561207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCJ8790001OtherBLUE SHIELD
MD75859902OtherBLUE SHIELD
DCP00200569OtherRAILROAD MED
DCJ8790001OtherBLUE SHIELD
DCP00200569OtherRAILROAD MED