Provider Demographics
NPI:1518960376
Name:BERLACHER, PAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:BERLACHER
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 1:2940 N MCCORD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1753
Mailing Address - Country:US
Mailing Address - Phone:419-842-3094
Mailing Address - Fax:419-842-3048
Practice Address - Street 1:2940 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1753
Practice Address - Country:US
Practice Address - Phone:419-842-3094
Practice Address - Fax:419-842-3048
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046095B207RC0000X
MI4301084745207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00975134OtherRRMC
OH0528521Medicaid
P00711881OtherRRMC
OH4134627Medicare PIN
OH00119123Medicare PIN
OH4048503Medicare PIN
OH4048507Medicare PIN
OH4134623Medicare PIN
OH4134625Medicare PIN
OH4134628Medicare PIN
MIP00975134OtherRRMC
OH0528521Medicaid
OH4134624Medicare PIN
OH4048505Medicare PIN
P00711881OtherRRMC
OH4134622Medicare PIN
0N23450Medicare PIN
MIMI1635005Medicare PIN
OH4134626Medicare PIN