Provider Demographics
NPI:1942261326
Name:OBERHEIM, WILLIAM STEVEN (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:STEVEN
Last Name:OBERHEIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109100208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00335406Medicaid
NYRA4813Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
NYRA4814Medicare PIN
NY00335406Medicaid