Healthcare Provider Details

I. General information

NPI: 1154927697
Provider Name (Legal Business Name): DEVIN EDWARD OBERMEYER IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 SMITH RD
NEWPORT RI
02841-1006
US

IV. Provider business mailing address

43 SMITH RD
NEWPORT RI
02841-1006
US

V. Phone/Fax

Practice location:
  • Phone: 513-379-8449
  • Fax:
Mailing address:
  • Phone: 513-379-8449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number1154927697
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: