Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3013 | MD |
Y | 103T00000X | Psychologist | 3013 | MD |
NPI | 1013960889 |
---|---|
Provider Name | Donald L Oberg |
First Address | University Park, MD 20782-1106 |
Second Address | University Park, MD 20782-1106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |