Provider Demographics
NPI:1992718068
Name:O'BRIEN, MARIA R (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:R
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:61 BRADLEY ST.
Mailing Address - Street 2:SUITE7
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010
Mailing Address - Country:US
Mailing Address - Phone:860-314-6898
Mailing Address - Fax:860-314-6896
Practice Address - Street 1:61 BRADLEY ST
Practice Address - Street 2:SUITE7
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5103
Practice Address - Country:US
Practice Address - Phone:860-314-6898
Practice Address - Fax:860-314-6896
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT038427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH19012Medicare UPIN