Provider Demographics
NPI:1841216868
Name:WILLIAM S. OBERHEIM, MD PC
Entity Type:Organization
Organization Name:WILLIAM S. OBERHEIM, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:OBERHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-434-2763
Mailing Address - Street 1:63 SHAKER ROAD
Mailing Address - Street 2:SUITE 202 ALBANY MEMORIAL PROFESSIONAL BUILDING
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1030
Mailing Address - Country:US
Mailing Address - Phone:518-434-2763
Mailing Address - Fax:518-434-0730
Practice Address - Street 1:63 SHAKER ROAD
Practice Address - Street 2:SUITE 202 ALBANY MEMORIAL PROFESSIONAL BUILDING
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1030
Practice Address - Country:US
Practice Address - Phone:518-434-2763
Practice Address - Fax:518-434-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109100208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02593108Medicaid
NY00335406Medicaid
NYQ28071Medicare UPIN
NYRA4813Medicare ID - Type Unspecified
NY00335406Medicaid
NYRA4814Medicare ID - Type Unspecified