Provider Demographics
NPI:1245292176
Name:OBERLANDER, MARK D (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:OBERLANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9375 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782
Mailing Address - Country:US
Mailing Address - Phone:727-541-4469
Mailing Address - Fax:727-546-9661
Practice Address - Street 1:9375 66TH ST N
Practice Address - Street 2:EYE ASSOCIATES OF PINELLAS
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782
Practice Address - Country:US
Practice Address - Phone:727-541-4469
Practice Address - Fax:727-546-9661
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076079207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254265000Medicaid
43630Medicare ID - Type Unspecified
FL254265000Medicaid