Basic Information
| Provider Information | |||||||||
| NPI: | 1891752572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OCONNOR | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 297 NORTH ST STE 221 | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026015133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086287777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33 EDGERTON DR | ||||||||
| Address2: | |||||||||
| City: | NORTH FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025562821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087784777 | ||||||||
| FaxNumber: | 5087719555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 06/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 49959 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2081598 | 05 | MA | MEDICAID |