Provider Demographics
NPI:1215980313
Name:O'BRIEN, GERALD M (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:M
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 1:4745 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2067
Mailing Address - Country:US
Mailing Address - Phone:302-368-5515
Mailing Address - Fax:302-366-1240
Practice Address - Street 1:4745 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 220
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-368-5515
Practice Address - Fax:302-366-1240
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006061207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0906208002OtherCIGNA
290754OtherMAMSI
1356478OtherINDEPENDENCE BCBS
DE0000685101Medicaid
MD60959301OtherCAREFIRST BCBS
DE0000658101Medicaid
105619OtherCOVENTRY
2049044000OtherAMERIHEALTH/KEYSTONE
4618046OtherAETNA/USHC
DE0000658101Medicaid
MD60959301OtherCAREFIRST BCBS
4618046OtherAETNA/USHC