Provider Demographics
NPI:1760578900
Name:THE O'BRIEN HEALTH CENTER
Entity Type:Organization
Organization Name:THE O'BRIEN HEALTH CENTER
Other - Org Name:ROBERT E. O'BRIEN, MD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-655-3000
Mailing Address - Street 1:18 MANSION ST
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-2030
Mailing Address - Country:US
Mailing Address - Phone:802-655-3000
Mailing Address - Fax:802-655-7753
Practice Address - Street 1:18 MANSION ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-2030
Practice Address - Country:US
Practice Address - Phone:802-655-3000
Practice Address - Fax:802-655-7753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8121207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT8369OtherBC/BS OF VT
VT0009737Medicaid
VT11V069OtherMVP
VT0009737Medicaid