Provider Demographics
NPI:1215297270
Name:O'CONNOR, MARK JOSEPH JR (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:O'CONNOR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:J
Other - Last Name:O'CONNOR
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 HOSPITAL RD STE 3A-B
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2253
Mailing Address - Country:US
Mailing Address - Phone:978-534-3179
Mailing Address - Fax:978-840-3161
Practice Address - Street 1:100 HOSPITAL RD STE 3A-B
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2253
Practice Address - Country:US
Practice Address - Phone:978-534-3179
Practice Address - Fax:978-840-3161
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA277574207RC0000X
RIMD15018207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110103978AMedicaid