Provider Demographics
NPI:1699969295
Name:OBRIEN, MARY PATRICIA (RPA-C)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:PATRICIA
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6199 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1024
Mailing Address - Country:US
Mailing Address - Phone:716-206-0390
Mailing Address - Fax:716-206-0394
Practice Address - Street 1:6199 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1024
Practice Address - Country:US
Practice Address - Phone:716-206-0390
Practice Address - Fax:716-206-0394
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005470-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant