Provider Demographics
NPI:1992745632
Name:O'BRYAN, JOHN JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:O'BRYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NORTHERN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-1821
Mailing Address - Country:US
Mailing Address - Phone:518-237-7363
Mailing Address - Fax:518-237-8995
Practice Address - Street 1:200 NORTHERN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-1821
Practice Address - Country:US
Practice Address - Phone:518-237-7363
Practice Address - Fax:518-237-8995
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169022-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08019OtherMVP
NY10002770OtherCAPITAL DISTRICT PHYSICIA
NY080014389OtherRAILROAD MEDICARE
NY000401303001OtherBLUE SHIELD NENY
NY01074120Medicaid
NY29F291OtherEMPIRE BC-BS
NY000401303001OtherBLUE SHIELD NENY
NY01074120Medicaid