Basic Information
| Provider Information | |||||||||
| NPI: | 1609940287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'CONNOR | ||||||||
| FirstName: | LINH | ||||||||
| MiddleName: | NGUYEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2555 COURT DR STE 450 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046717652 | ||||||||
| FaxNumber: | 7046717656 | ||||||||
| Practice Location | |||||||||
| Address1: | 2555 COURT DR STE 450 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046717652 | ||||||||
| FaxNumber: | 7046717656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2017-01424 | NC | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 036093594 | IL | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 036093594 | 05 | IL | MEDICAID | 400280 | 01 | IL | GROUP MEDICARE PTAN | OTHER |