Provider Demographics
NPI:1245489988
Name:O'BRIEN, EDWARD MITCHELL (LAC MMQ)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MITCHELL
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:LAC MMQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 FAIRFIELD RD.
Mailing Address - Street 2:SUITE E
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325
Mailing Address - Country:US
Mailing Address - Phone:717-586-7044
Mailing Address - Fax:717-334-4481
Practice Address - Street 1:2311 FAIRFIELD RD.
Practice Address - Street 2:SUITE E
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325
Practice Address - Country:US
Practice Address - Phone:717-586-7044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK644171100000X
MD400961171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist