Provider Demographics
NPI:1457419491
Name:O'CONNOR, CAROLYN BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:BETH
Last Name:O'CONNOR
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 1:401 ROUTE 73 N BLDG 10, SUITE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:267-405-3330
Mailing Address - Fax:856-762-1775
Practice Address - Street 1:794 PENLLYN BLUE BELL PIKE STE 218
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1669
Practice Address - Country:US
Practice Address - Phone:267-405-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62445207R00000X
PAMD463445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412064700Medicaid
MD710LP147Medicare PIN
G00292Medicare UPIN
MDP00452826Medicare PIN
S883K923Medicare ID - Type Unspecified