Provider Demographics
NPI:1346322096
Name:BERGER, BERNHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNHARD
Middle Name:
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 1:1455 HARRISON AVE NW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-456-7965
Mailing Address - Fax:330-456-0333
Practice Address - Street 1:1455 HARRISON AVE NW
Practice Address - Street 2:SUITE 204
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708
Practice Address - Country:US
Practice Address - Phone:330-456-7965
Practice Address - Fax:330-456-0333
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3540581207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0393257Medicaid
OHBE0441293Medicare PIN
OH0393257Medicaid