Provider Demographics
NPI:1780760371
Name:O'HARA, KAY B (DC)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:B
Last Name:O'HARA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-4296
Mailing Address - Country:US
Mailing Address - Phone:410-686-1117
Mailing Address - Fax:410-686-1751
Practice Address - Street 1:616 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-4907
Practice Address - Country:US
Practice Address - Phone:410-686-1117
Practice Address - Fax:410-686-1751
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350056177OtherRR MEDICARE
4234464OtherAETNA
MDK104KAOtherCAREFIRST
MDT1390001OtherCAREFIRST
483012OtherUNITEDHEALTHCARE
MD624QMedicare PIN
U05314Medicare UPIN