Provider Demographics
NPI:1699242883
Name:OBERKIRSCH, SVETLANA (PA)
Entity type:Individual
Prefix:MS
First Name:SVETLANA
Middle Name:
Last Name:OBERKIRSCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SVIJETLANA
Other - Middle Name:
Other - Last Name:OBERKIRSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:755 HIGHLAND OAKS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-7106
Mailing Address - Country:US
Mailing Address - Phone:704-237-4240
Mailing Address - Fax:
Practice Address - Street 1:280 EXECUTIVE PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1838
Practice Address - Country:US
Practice Address - Phone:704-237-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08988363AM0700X
001008988363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical