Provider Demographics
NPI:1114944600
Name:OBERLY, JULIE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LYNN
Last Name:OBERLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3111 LOTZ AVE SE
Mailing Address - Street 2:
Mailing Address - City:EAST CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44730-9727
Mailing Address - Country:US
Mailing Address - Phone:330-488-5404
Mailing Address - Fax:330-488-3047
Practice Address - Street 1:1401 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720
Practice Address - Country:US
Practice Address - Phone:330-497-8636
Practice Address - Fax:330-497-8634
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35076929O207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2243594Medicaid
OH2243594Medicaid
OB4050081Medicare ID - Type Unspecified