Provider Demographics
NPI:1912964933
Name:O'BRIEN, PAUL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDWARD
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:SUITE 435
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7615
Mailing Address - Country:US
Mailing Address - Phone:937-434-3180
Mailing Address - Fax:937-434-9807
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:SUITE 435
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7615
Practice Address - Country:US
Practice Address - Phone:937-434-3180
Practice Address - Fax:937-434-9807
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-8065-0208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311047540-00OtherWORKER'S COMPENSATION #
OH0408366Medicaid
OH311047540-00OtherWORKER'S COMPENSATION #
OH0467563Medicare PIN