Provider Demographics
NPI:1144226424
Name:AKERBERG, FRED L (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:L
Last Name:AKERBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 6TH AVE
Mailing Address - Street 2:# D303
Mailing Address - City:MONTGOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:25136-2116
Mailing Address - Country:US
Mailing Address - Phone:304-233-9314
Mailing Address - Fax:304-233-0265
Practice Address - Street 1:497 MALL RD
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-6216
Practice Address - Country:US
Practice Address - Phone:304-469-2905
Practice Address - Fax:304-465-1518
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0050281000Medicaid
WV0531364Medicare PIN
D49124Medicare UPIN
WV0050281000Medicaid