Provider Demographics
NPI:1548438120
Name:SUSQUEHANNA ORTHOPAEDICS ASSOCIATES JOHN P OHEARN MD LLC
Entity type:Organization
Organization Name:SUSQUEHANNA ORTHOPAEDICS ASSOCIATES JOHN P OHEARN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:O'HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-879-9636
Mailing Address - Street 1:2 COLGATE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2624
Mailing Address - Country:US
Mailing Address - Phone:410-879-9636
Mailing Address - Fax:410-879-0376
Practice Address - Street 1:2 COLGATE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2624
Practice Address - Country:US
Practice Address - Phone:410-879-9636
Practice Address - Fax:410-879-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD277LOtherMEDICARE
DCE470-0001OtherCAREFIRST
MD961531800OtherMEDICAL ASSISTANCE
GADC3950OtherRAILROAD MEDICARE
MD6329520001Medicare NSC