Provider Demographics
NPI:1730470204
Name:OBENREDER, THOMAS LEO (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEO
Last Name:OBENREDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 HANNON RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-4450
Mailing Address - Country:US
Mailing Address - Phone:814-899-3793
Mailing Address - Fax:
Practice Address - Street 1:3232 HANNON RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-4450
Practice Address - Country:US
Practice Address - Phone:814-899-3793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005654L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine