Provider Demographics
NPI:1871715771
Name:OBARA, JACEK ZDZISLAW (MD)
Entity type:Individual
Prefix:
First Name:JACEK
Middle Name:ZDZISLAW
Last Name:OBARA
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 1:11 ROBINSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-6421
Mailing Address - Country:US
Mailing Address - Phone:610-326-9460
Mailing Address - Fax:
Practice Address - Street 1:11 ROBINSON ST STE 100
Practice Address - Street 2:COMMUNITY HEALTH AND DENTAL CARE
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-6421
Practice Address - Country:US
Practice Address - Phone:610-326-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235325207Q00000X
PAMD443274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine