MEDICARE: MRS. PAMELA A OBERT CCCA

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	231H00000X	Audiologist	35	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AD0048	OTHER	MA	BC/BS OF MASSACHUSETTS

General Provider Information

NPI Number	:	1821041120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA A OBERT CCCA

Provider Business Mailing Address
First Line	:	725 NORTH STREET
Second Line	:
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-4124
Country	:	US
Telephone Number	:	413-447-2225
Fax Number	:	413-346-6798

Provider Business Practice Location Address
First Line	:	510 NORTH STREET
Second Line	:	SUITE 6 ROOM 202
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-4117
Country	:	US
Telephone Number	:	413-447-2225
Fax Number	:	413-346-6798

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	09/03/2019

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