Provider Demographics
NPI:1104808138
Name:O'BRIEN, AUSTIN JOHN (MD)
Entity type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:JOHN
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 PAWTUCKET BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2042
Mailing Address - Country:US
Mailing Address - Phone:978-459-8447
Mailing Address - Fax:978-459-6125
Practice Address - Street 1:595 PAWTUCKET BLVD. 2ND FL
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-459-8447
Practice Address - Fax:978-459-6125
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ13899OtherBS
MA3116930Medicaid
F61457Medicare UPIN
OBJ13899Medicare ID - Type Unspecified