Provider Demographics
NPI:1295808574
Name:OBANION, KATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:OBANION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:1210 BRACE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3213
Practice Address - Country:US
Practice Address - Phone:856-938-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46139207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ160035683OtherRR MEDICARE
NJ460284OtherPA BS HIGHMARK
NJP597174OtherOXFORD
NJ3K6132OtherHEALTHNET
NJ000460284OtherAMERIHEALTH PPO/PA BS
NJ1265387OtherUNITED HEALTHCARE
NJ4208532OtherCIGNA
NJ1087148OtherHORIZON NJ HEALTH
NJ2749686OtherAETNA
NJ010003739OtherAMERICHOICE
NJ3838609Medicaid
NJ0106971000OtherAMERIHEALTH/KEYSTONE/IBC
NJ0535060OtherAETNA
NJ460284OtherPA BS HIGHMARK
NJ3K6132OtherHEALTHNET