Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 35-055484 | OH |
NPI | 1033138938 |
---|---|
Provider Name | Bruce E Berger |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 29/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000224367 | UNISON (01) | |
000000539529 | ANTHEM (01) | |
0743717 | (05) | OH |
2168560 | AETNA (01) | |
363354 | WELLCARE (01) | |
390006418 | RAILROAD MEDICARE (01) | OH |
741797 | BUCKEYE (01) | |
A17734 | (02) |