Basic Information
| Provider Information | |||||||||
| NPI: | 1861476947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OCONNOR | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | COLUM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9142 | ||||||||
| Address2: | MASS GENERAL PHYSICIAN ORGANIZATION | ||||||||
| City: | CHARLESTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021299142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175732770 | ||||||||
| FaxNumber: | 6175732769 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 NASHUA ST | ||||||||
| Address2: | SPAULDING REHAB HOSPITAL | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021141198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175732200 | ||||||||
| FaxNumber: | 6175732769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 09/07/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 214129 | MA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P0004X | 214129 | MA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine |
ID Information
| ID | Type | State | Issuer | Description | J25253 | 01 | MA | BCBS MA | OTHER | 214129 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 0196312 | 05 | MA | MEDICAID |