MEDICARE: DITA OBLER MS, CGC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1215994488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DITA OBLER MS, CGC

Provider Business Mailing Address
First Line	:	318 BROOKLINE ST
Second Line	:	UNIT 2
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-4812
Country	:	US
Telephone Number	:	617-869-7567
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 BROOKLINE ST
Second Line	:	UNIT 2
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-4812
Country	:	US
Telephone Number	:	617-869-7567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	11/24/2008

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