Provider Demographics
NPI:1487911814
Name:O'BRIEN, LUCY KATHLEEN (DO)
Entity type:Individual
Prefix:DR
First Name:LUCY
Middle Name:KATHLEEN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2244 WINFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2877
Mailing Address - Country:US
Mailing Address - Phone:810-624-1675
Mailing Address - Fax:440-743-8131
Practice Address - Street 1:303 E ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2591
Practice Address - Country:US
Practice Address - Phone:440-743-8130
Practice Address - Fax:440-743-8131
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH427980Medicare PIN