Provider Demographics
NPI:1871752444
Name:O'LEARY, MIRIAM A (MD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:A
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WASHINGTON ST
Mailing Address - Street 2:#850
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-3030
Mailing Address - Fax:617-636-1479
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:#850
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-3030
Practice Address - Fax:617-636-1479
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218974207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology