Provider Demographics
NPI:1861431959
Name:O'NEILL, MARY JOAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY JOAN
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 OLD BROOK RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-5409
Mailing Address - Country:US
Mailing Address - Phone:508-845-0127
Mailing Address - Fax:
Practice Address - Street 1:14 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3003
Practice Address - Country:US
Practice Address - Phone:508-422-2810
Practice Address - Fax:508-634-3276
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152946207P00000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0008333OtherNHP
34623OtherFALLON
J18057OtherBLUE CROSS BLUE SHIELD
999541OtherNETWORK HEALTH
000000021079OtherBMC HEALTHNET
613214OtherHARVARD PILGRIM HEALTH CARE
930104656OtherRAILROAD MEDICARE
152946OtherTUFTS
MA3172155Medicaid
930104656OtherRAILROAD MEDICARE