Healthcare Provider Details

I. General information

NPI: 1104422666
Provider Name (Legal Business Name): ERIC MICHAEL OBERLE AG-ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 OSLER DR
TOWSON MD
21204-7700
US

IV. Provider business mailing address

101 SIEBER CT
NEWARK DE
19711-8522
US

V. Phone/Fax

Practice location:
  • Phone: 337-410-1000
  • Fax:
Mailing address:
  • Phone: 845-489-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAC003463
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberL1-0040548
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: