Provider Demographics
NPI:1801883806
Name:O'LEARY, ROBERT JOSEPH JR (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:O'LEARY
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:JOSEPH
Other - Last Name:O'LEARY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:536 BROAD ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-1362
Mailing Address - Country:US
Mailing Address - Phone:781-335-2063
Mailing Address - Fax:781-335-2097
Practice Address - Street 1:536 BROAD ST
Practice Address - Street 2:SUITE 9
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-1362
Practice Address - Country:US
Practice Address - Phone:781-335-2063
Practice Address - Fax:781-335-2097
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1843213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT58796Medicare UPIN
MAY70855Medicare PIN
MA0511370001Medicare NSC