Provider Demographics
NPI:1205845500
Name:HERSHBERGER, VERNON J (MD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:J
Last Name:HERSHBERGER
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 1:880 MULL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7522
Mailing Address - Country:US
Mailing Address - Phone:330-864-8898
Mailing Address - Fax:330-865-7350
Practice Address - Street 1:880 MULL AVE STE 100
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7522
Practice Address - Country:US
Practice Address - Phone:330-864-8898
Practice Address - Fax:330-865-7350
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18006363LP0808X
OH35.038491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0331037Medicaid
OH0414134Medicare ID - Type Unspecified
A75378Medicare UPIN
OH0331037Medicaid