Provider Demographics
NPI:1144335480
Name:O'DEA, MAUREEN THERESA (MD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:THERESA
Last Name:O'DEA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2296 OPITZ BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3300
Mailing Address - Country:US
Mailing Address - Phone:703-580-5348
Mailing Address - Fax:703-580-5618
Practice Address - Street 1:2296 OPITZ BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3300
Practice Address - Country:US
Practice Address - Phone:703-580-5348
Practice Address - Fax:703-580-5618
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2008-05-16
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Provider Licenses
StateLicense IDTaxonomies
VA0101044780207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE34479Medicare UPIN
VA180000864Medicare PIN