Provider Demographics
NPI:1356582571
Name:O'BRIEN, MIECHELLE L (MD)
Entity type:Individual
Prefix:
First Name:MIECHELLE
Middle Name:L
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OSBORNE STREET- STE 121
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6019
Mailing Address - Country:US
Mailing Address - Phone:203-739-7010
Mailing Address - Fax:203-739-1517
Practice Address - Street 1:111 OSBORNE STREET- STE 121
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6019
Practice Address - Country:US
Practice Address - Phone:203-739-7010
Practice Address - Fax:203-739-1517
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047450207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology