Provider Demographics
NPI:1861417701
Name:O'CONNOR, MAUREEN E (MD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:E
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAUREEN
Other - Middle Name:E
Other - Last Name:O'CONNOR-BROSNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:615 CHESTNUT ST
Mailing Address - Street 2:14TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4404
Mailing Address - Country:US
Mailing Address - Phone:215-955-9628
Mailing Address - Fax:215-955-2420
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:SUITE 8490
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-6161
Practice Address - Fax:215-923-5507
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012820E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000747195Medicaid
NJ5028205Medicaid
PA055315Medicare PIN