Provider Demographics
NPI:1316076607
Name:NEIL S OCONNOR
Entity type:Organization
Organization Name:NEIL S OCONNOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-270-7903
Mailing Address - Street 1:800 TIFFANY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1807
Mailing Address - Country:US
Mailing Address - Phone:252-985-1371
Mailing Address - Fax:
Practice Address - Street 1:402 PALM BLVD
Practice Address - Street 2:
Practice Address - City:ISLE OF PALMS
Practice Address - State:SC
Practice Address - Zip Code:29451-2146
Practice Address - Country:US
Practice Address - Phone:843-270-7903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC153213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T64091Medicare UPIN
SCT640918820Medicare PIN