MEDICARE: DR. GARY D OBERG 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	2084P0800X	Psychiatry Physician	150573-1	NY

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

General Provider Information

NPI Number	:	1407820954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY D OBERG M.D.

Provider Business Mailing Address
First Line	:	211 CHURCH ST
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1046
Country	:	US
Telephone Number	:	518-584-9030
Fax Number	:	518-581-1709

Provider Business Practice Location Address
First Line	:	211 CHURCH ST
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1046
Country	:	US
Telephone Number	:	518-584-9030
Fax Number	:	518-581-1709

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	08/06/2008

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