Provider Demographics
NPI:1851812218
Name:O'CONNOR, MICHAEL CHARLES JR (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHARLES
Last Name:O'CONNOR
Suffix:JR
Gender:
Credentials:MD
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Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 NEVINS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-779-6382
Practice Address - Fax:617-789-2307
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2025-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.160359208G00000X
MA1020222208G00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3148103Medicaid
MA110214335AMedicaid