Provider Demographics
NPI:1447951330
Name:OBERIO, GIDEON JUN
Entity type:Individual
Prefix:
First Name:GIDEON
Middle Name:JUN
Last Name:OBERIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 CATHEDRAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4430
Mailing Address - Country:US
Mailing Address - Phone:443-438-7863
Mailing Address - Fax:443-957-9485
Practice Address - Street 1:309 CATHEDRAL ST STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4430
Practice Address - Country:US
Practice Address - Phone:443-438-7863
Practice Address - Fax:443-957-9485
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194509163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse