Provider Demographics
NPI:1730116815
Name:O'CONNOR, COLLEEN E (PA)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:E
Last Name:O'CONNOR
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Gender:F
Credentials:PA
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Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:GRB 109
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-8514
Mailing Address - Fax:617-724-6747
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRB 109
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-8514
Practice Address - Fax:617-724-6747
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-08-24
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Provider Licenses
StateLicense IDTaxonomies
MA2387363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant