Provider Demographics
NPI:1962448050
Name:OBRIEN, STEPHEN T (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:T
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:113 ELM ST
Mailing Address - Street 2:STE 302
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-741-3069
Mailing Address - Fax:860-745-3864
Practice Address - Street 1:113 ELM ST
Practice Address - Street 2:ENFIELD FAMILY MEDICINE STE 302
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-741-3069
Practice Address - Fax:860-745-3864
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2009-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT019445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1962448050Medicaid
CT080135196OtherRAILROAD MEDICARE
CT080001294Medicare PIN
D32611Medicare UPIN