Provider Demographics
NPI:1316027774
Name:OBERDICK, JASON D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:D
Last Name:OBERDICK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-7190
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1000 STONEWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8386
Practice Address - Country:US
Practice Address - Phone:724-778-3020
Practice Address - Fax:724-778-3024
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA003384L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP26932Medicare UPIN
PAP26932Medicare UPIN