Provider Demographics
NPI:1578502381
Name:OBERNEDER, BRIAN R (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:OBERNEDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:903 OLD SCALP AVE
Mailing Address - Street 2:APT 275
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-1763
Mailing Address - Country:US
Mailing Address - Phone:814-255-9100
Mailing Address - Fax:814-255-9103
Practice Address - Street 1:903 OLD SCALP AVE
Practice Address - Street 2:APT 275
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1763
Practice Address - Country:US
Practice Address - Phone:814-255-9100
Practice Address - Fax:814-255-9103
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004564R213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA053847OtherHIGHMARK FREEDOM BLUE
PA053847OtherHIGHMARK MEDIGAP BLUE
PA1514662OtherPA MEDICARE ASSURED
PA216097OtherUPMC
PA341951OtherHEALTH ASSURANCE
PA037765OtherHGS ADMINISTRATORS
PA150686OtherUNISON
PA0018074670004Medicaid
002072568OtherUNITED HEALTHCARE
PA053847OtherHIGHMARK
PA0018074670004OtherMEDICAL ASSISTANCE DPA
PA136392OtherHEALTH AMERICA
PA053847OtherSECURITY BLUE
PA053847OtherKEYSONE BLUE
PA053847OtherKEYSTONE HEALTH PLAN WEST
PA341951OtherHEALTH ASSURANCE
PA150686OtherUNISON