Provider Demographics
NPI:1760451975
Name:O'CONNOR, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1741
Mailing Address - Country:US
Mailing Address - Phone:610-966-4646
Mailing Address - Fax:610-965-6201
Practice Address - Street 1:3760 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-1741
Practice Address - Country:US
Practice Address - Phone:610-966-4646
Practice Address - Fax:610-965-6201
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007620L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014101660005Medicaid
PA402381OtherBLUE CROSS / BLUE SHIELD
PA01217501OtherCAPITAL BLUE CROSS
PAP00644919OtherRAILROAD MEDICARE
PA402381WPMMedicare PIN
PA402381OtherBLUE CROSS / BLUE SHIELD