Healthcare Provider Details

I. General information

NPI: 1447951330
Provider Name (Legal Business Name): GIDEON JUN OBERIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 CATHEDRAL ST STE 200
BALTIMORE MD
21201-4430
US

IV. Provider business mailing address

309 CATHEDRAL ST STE 200
BALTIMORE MD
21201-4430
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-7863
  • Fax: 443-957-9485
Mailing address:
  • Phone: 443-438-7863
  • Fax: 443-957-9485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR194509
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR194509
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: