Provider Demographics
NPI:1861476947
Name:OCONNOR, KEVIN COLUM (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:COLUM
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-573-2770
Mailing Address - Fax:617-573-2769
Practice Address - Street 1:125 NASHUA ST
Practice Address - Street 2:SPAULDING REHAB HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1198
Practice Address - Country:US
Practice Address - Phone:617-573-2200
Practice Address - Fax:617-573-2769
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2012-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA214129208100000X, 2081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ25253OtherBCBS MA
MA214129OtherTUFTS HEALTH PLAN
MA0196312Medicaid
MAJ25253OtherBCBS MA
MA214129OtherTUFTS HEALTH PLAN