Provider Demographics
NPI:1164404349
Name:BERBERICH, NORBERT JOHN III (MD)
Entity Type:Individual
Prefix:
First Name:NORBERT
Middle Name:JOHN
Last Name:BERBERICH
Suffix:III
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 1:20 MEDICAL VILLAGE DRIVE SUITE 258
Mailing Address - Street 2:ANESTHESIA INTENSIVE CARE CONSULTANTS INC
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-341-7246
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:7500 STATE ROAD
Practice Address - Street 2:ANESTHESIA INTENSIVE CARE CONSULTANTS INC
Practice Address - City:CIUCIUNATI
Practice Address - State:OH
Practice Address - Zip Code:45255
Practice Address - Country:US
Practice Address - Phone:859-341-7246
Practice Address - Fax:859-341-7867
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060393B207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000361336OtherANTHEM BLUE SHIELD
OH0931835Medicaid
KY64932916Medicaid
4338628OtherAETNA
000000361336OtherANTHEM BLUE SHIELD
OHBE0751924Medicare ID - Type Unspecified
OH0931835Medicaid