Provider Demographics
NPI:1104887884
Name:O'BRIEN, MICHAEL FRANCIS (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SITTERLY RD STE 2300
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5646
Mailing Address - Country:US
Mailing Address - Phone:518-579-2650
Mailing Address - Fax:518-579-2670
Practice Address - Street 1:103 SITTERLY RD STE 2300
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-579-2650
Practice Address - Fax:518-579-2670
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003610-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY324371OtherMVP PROVIDER NUMBER
NY324371OtherMVP PROVIDER NUMBER
DD0376Medicare PIN