Provider Demographics
NPI:1548248974
Name:O'HEARN, JOHN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:O'HEARN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018602207X00000X
MDD18602207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6329520001OtherMEDICARE DME
DCE470-0001OtherCAREFIRST
MD277L531BOtherMEDICARE
GAP00166020OtherRAILROAD MEDICARE
MD961531800OtherMEDICAL ASSISTANCE