Healthcare Provider Details

I. General information

NPI: 1083698229
Provider Name (Legal Business Name): MARK FRANCIS OBENRADER MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 PENNSYLVANIA AVE 2ND FL SUITE A
FORT WASHINGTON PA
19034-3314
US

IV. Provider business mailing address

PO BOX 820933
PHILADELPHIA PA
19182-0933
US

V. Phone/Fax

Practice location:
  • Phone: 215-540-8408
  • Fax: 215-540-8418
Mailing address:
  • Phone: 215-540-8408
  • Fax: 215-540-8418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD025847E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: