Provider Demographics
NPI:1063514610
Name:O'GRADY, WILLIAM BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRIAN
Last Name:O'GRADY
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 1:644 OCEANVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730-1221
Mailing Address - Country:US
Mailing Address - Phone:732-528-0765
Mailing Address - Fax:732-286-7040
Practice Address - Street 1:707 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6517
Practice Address - Country:US
Practice Address - Phone:732-244-2666
Practice Address - Fax:732-286-7040
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO24172207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C57406Medicare UPIN
NJOG123732Medicare ID - Type Unspecified