Provider Demographics
NPI:1760167977
Name:HENDERSON BERG, MEAGAN-HELEN (MDCM (MD))
Entity Type:Individual
Prefix:DR
First Name:MEAGAN-HELEN
Middle Name:
Last Name:HENDERSON BERG
Suffix:
Gender:F
Credentials:MDCM (MD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 GOVERNOR'S PLACE BLVD DAYTON SKIN CARE,
Mailing Address - Street 2:ATTN: IRINA LACHUGINA
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409
Mailing Address - Country:US
Mailing Address - Phone:937-293-5567
Mailing Address - Fax:937-293-5568
Practice Address - Street 1:3025 GOVERNOR'S PLACE BLVD DAYTON SKIN CARE,
Practice Address - Street 2:ATTN: IRINA LACHUGINA
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:937-293-5567
Practice Address - Fax:937-293-5568
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.147813207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty