Healthcare Provider Details

I. General information

NPI: 1164150942
Provider Name (Legal Business Name): CARLOS LUIS OBERTO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 N PENNSYLVANIA AVE
WILKES BARRE PA
18701-3603
US

IV. Provider business mailing address

1047 COUNTRY PLACE DR
TOBYHANNA PA
18466-7954
US

V. Phone/Fax

Practice location:
  • Phone: 570-491-0126
  • Fax:
Mailing address:
  • Phone: 347-812-7992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD489777
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: