Provider Demographics
NPI:1801079678
Name:EDWARD J. O'CONNOR, MD, INC.
Entity type:Organization
Organization Name:EDWARD J. O'CONNOR, MD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-5968
Mailing Address - Street 1:2811 WILSHIRE BLVD STE 790
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4805
Mailing Address - Country:US
Mailing Address - Phone:310-829-5968
Mailing Address - Fax:310-453-3685
Practice Address - Street 1:2811 WILSHIRE BLVD STE 790
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4805
Practice Address - Country:US
Practice Address - Phone:310-829-5968
Practice Address - Fax:310-453-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA244002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADE4737OtherRAILROAD MEDICARE
CAA24400OtherMEDICARE
CAB49981Medicare UPIN
CAW19720Medicare PIN