MEDICARE: WALLACE OBENSHAIN MD

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	207Q00000X	Family Medicine Physician	D0035779	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080176795	OTHER	MD	MEDICARE RAILROAD

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	:	1568410603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALLACE OBENSHAIN MD

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	ELKTON
State	:	MD
Zip	:	21922-0190
Country	:	US
Telephone Number	:	410-398-4679
Fax Number	:	410-620-3686

Provider Business Practice Location Address
First Line	:	251 S BOHEMIA AVE
Second Line	:
City	:	CECILTON
State	:	MD
Zip	:	21913-0670
Country	:	US
Telephone Number	:	410-275-8157
Fax Number	:	410-275-9919

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/06/2012

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Directions to “ WALLACE OBENSHAIN MD” Practice Location

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