Healthcare Provider Details

I. General information

NPI: 1255440491
Provider Name (Legal Business Name): KATHLEEN OBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/24/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WATER ST SUITE 0610
BLUE HILL ME
04614-5231
US

IV. Provider business mailing address

57 WATER ST SUITE 0610
BLUE HILL ME
04614-5231
US

V. Phone/Fax

Practice location:
  • Phone: 207-374-3940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD18007
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: