Provider Demographics
NPI:1275554776
Name:BERGER, MELVIN N (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:N
Last Name:BERGER
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 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:1ST FL, MSC9152
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6299
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:216-286-6341
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND35-0508862080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011201010003OtherPA MEDICAID
OH000000221094OtherUNISON
OH000000525881OtherANTHEM
OH0562958Medicaid
NE10025555600OtherNE MEDICAID
OH363425OtherWELLCARE
OH738034OtherBUCKEYE
OH0562958OtherBCMH
OHP00412298OtherRAILROAD MEDICARE
OH000000028073OtherANTHEM
OH639478OtherAETNA
OH370001899OtherRAILROAD MEDICARE
WV3810012322OtherWV MEDICAID
OHBE0558591Medicare PIN
OH0562958OtherBCMH
NE10025555600OtherNE MEDICAID