Provider Demographics
NPI:1336162262
Name:O HARA, MARTIN J (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:O HARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:611 S CARLIN SPRINGS RD
Mailing Address - Street 2:STE 409
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1087
Mailing Address - Country:US
Mailing Address - Phone:703-527-1400
Mailing Address - Fax:703-525-0043
Practice Address - Street 1:1715 N GEORGE MASON DRIVE
Practice Address - Street 2:SUITE 107
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205
Practice Address - Country:US
Practice Address - Phone:703-527-1400
Practice Address - Fax:703-525-0043
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2017-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101049608207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5878209Medicaid
2630085OtherECFMG
VA5878209Medicaid
2630085OtherECFMG