Healthcare Provider Details

I. General information

NPI: 1487627824
Provider Name (Legal Business Name): MARC OBADIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 EAST 34TH ST
NEW YORK NY
10016
US

IV. Provider business mailing address

PO BOX 95000-2454
PHILADELPHIA PA
19195-2454
US

V. Phone/Fax

Practice location:
  • Phone: 212-252-6001
  • Fax: 212-252-6105
Mailing address:
  • Phone: 212-252-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number136264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: