Individual
DR. KEVIN COLUM OCONNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
125 NASHUA ST, SPAULDING REHAB HOSPITAL, BOSTON, MA 02114-1198
(617) 573-2200
(617) 573-2769
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 573-2770
(617) 573-2769
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
214129
MA
2081P0004X
Spinal Cord Injury Medicine Physician
Primary
214129
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0196312
—
MA
01
—
214129
TUFTS HEALTH PLAN
MA
01
—
J25253
BCBS MA
MA
Enumeration date
12/02/2005
Last updated
09/07/2012
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