Provider Demographics
NPI:1609285360
Name:OBA LLC
Entity Type:Organization
Organization Name:OBA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-756-5760
Mailing Address - Street 1:6 ELIOT CRESCENT
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02467
Mailing Address - Country:US
Mailing Address - Phone:773-756-5760
Mailing Address - Fax:773-714-1229
Practice Address - Street 1:6 ELIOT CRESCENT
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02467
Practice Address - Country:US
Practice Address - Phone:773-756-5760
Practice Address - Fax:773-714-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty