Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35083932 | OH |
Y | 2080P0204X | Pediatric Emergency Doctor | 35083932 | OH |
NPI | 1144214396 |
---|---|
Provider Name | Luciana Elisa Berg |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43213-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 14/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2478831 | (05) | OH |