1053402487 NPI number — DR. VINCENT J OBIAS M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053402487 NPI number — DR. VINCENT J OBIAS M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

OBIAS

Provider First Name:

VINCENT

Provider Middle Name:

J

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1053402487

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/30/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

6201 GREENLEIGH AVE DEPT OF

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MIDDLE RIVER

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21220-2004

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-933-2704

Provider Business Mailing Address Fax Number:

410-500-4266

Provider First Line Business Practice Location Address:

11100 EUCLID AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CLEVELAND

Provider Business Practice Location Address State Name:

OH

Provider Business Practice Location Address Postal Code:

44106-1716

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

216-844-7874

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/28/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208C00000X , with the licence number:  35-088664 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208C00000X , with the licence number: MD037351 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 208600000X , with the licence number: 35-088664 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208600000X , with the licence number: D94365 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 7309844 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 2713291 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 000000221424 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000503703 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 363886 . This is a "WELLCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 745044 . This is a "BUCKEYE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: P00372965 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".