Provider Demographics
NPI:1174243976
Name:OBRIEN, MARK CHARLES
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CHARLES
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-7507
Mailing Address - Country:US
Mailing Address - Phone:207-653-3036
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NEW ENGLAND
Practice Address - Street 2:716 STEVENS AVENUE
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103
Practice Address - Country:US
Practice Address - Phone:207-221-4516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program