Healthcare Provider Details

I. General information

NPI: 1013960889
Provider Name (Legal Business Name): DONALD L OBERG PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6713 44TH AVE
UNIVERSITY PARK MD
20782-1106
US

IV. Provider business mailing address

6713 44TH AVE
UNIVERSITY PARK MD
20782-1106
US

V. Phone/Fax

Practice location:
  • Phone: 301-220-0707
  • Fax: 301-699-1912
Mailing address:
  • Phone: 301-220-0707
  • Fax: 301-699-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3013
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: