Healthcare Provider Details

I. General information

NPI: 1295808574
Provider Name (Legal Business Name): KATHLEEN OBANION MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 BRACE RD SUITE 102
CHERRY HILL NJ
08034-3213
US

IV. Provider business mailing address

1 FEDERAL ST # 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-938-2090
  • Fax:
Mailing address:
  • Phone: 856-356-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMA46139
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: