Provider Demographics
NPI:1740381185
Name:O'BRIEN, EVAN DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:DOUGLAS
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 MATAWAN RD STE 302
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2653
Mailing Address - Country:US
Mailing Address - Phone:732-441-7177
Mailing Address - Fax:732-441-7165
Practice Address - Street 1:1225 N BROAD ST STE 3
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-1203
Practice Address - Country:US
Practice Address - Phone:856-845-0707
Practice Address - Fax:856-845-0082
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06352500207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2003795000OtherKEYSTONE HEALTH PLAN EAST
NJ232764000OtherHORIZON
NJ2003795000OtherAMERIHEALTH
NJ2003795000OtherKEYSTONE HEALTH PLAN EAST
NJ050893Medicare ID - Type Unspecified