Healthcare Provider Details

I. General information

NPI: 1538140223
Provider Name (Legal Business Name): ERIK D OBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 PARROT CREEK WAY
CHARLESTON SC
29412-9055
US

IV. Provider business mailing address

921 PARROT CREEK WAY
CHARLESTON SC
29412-9055
US

V. Phone/Fax

Practice location:
  • Phone: 843-693-2154
  • Fax:
Mailing address:
  • Phone: 843-693-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP2502
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number83775
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01057915A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01057915A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number36547
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: