Individual
DR. MARY ANN O'BRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3909 NEW VISION DR, FORT WAYNE, IN 46845-1725
(260) 496-6602
(260) 969-3065
Mailing address
1234 E DUPONT RD, SUITE 3, FORT WAYNE, IN 46825-1545
(260) 373-9700
(260) 458-5664
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01037346A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000005500
MPLAN
—
01
—
000000082547
ANTHEM
IN
05
—
104874481
—
MI
05
—
200033370
—
IN
05
—
2517226
—
OH
Enumeration date
09/14/2005
Last updated
09/20/2013
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