Provider Demographics
NPI:1720062011
Name:O'CONNOR, PHILIP J (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:O'CONNOR
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 1:81 WOODLANDS DR
Mailing Address - Street 2:STE 202
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1164
Mailing Address - Country:US
Mailing Address - Phone:207-781-4665
Mailing Address - Fax:
Practice Address - Street 1:81 WOODLANDS DR
Practice Address - Street 2:STE 202
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1164
Practice Address - Country:US
Practice Address - Phone:207-781-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4394207RG0100X
GA073618207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
002388OtherANTHEM
100010915OtherRAILROAD MEDICARE
1040125OtherAETNA
ME277480099Medicaid
1040125OtherAETNA
ME10160301Medicare PIN
1040125OtherAETNA