MEDICARE: MARY L OBERST M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MD-15388	HI
2	207RC0000X	Cardiovascular Disease Physician	0101269315	VA
3	207RC0000X	Cardiovascular Disease Physician	ME125665	FL
4	207RC0000X	Cardiovascular Disease Physician	42530	TN
5	207RC0000X	Cardiovascular Disease Physician	22894	OK
6	207RC0000X	Cardiovascular Disease Physician	51164	KY
7	207RC0000X	Cardiovascular Disease Physician	K4972	TX
8	207RC0000X	Cardiovascular Disease Physician	TP288	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174510168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY L OBERST M.D.

Provider Business Mailing Address
First Line	:	3450 11TH CT STE 102
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5012
Country	:	US
Telephone Number	:	772-778-8687
Fax Number	:	772-778-3680

Provider Business Practice Location Address
First Line	:	3450 11TH CT STE 102
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5012
Country	:	US
Telephone Number	:	772-778-8687
Fax Number	:	772-778-3680

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/23/2024

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