Provider Demographics
NPI:1821093410
Name:BERKOVITZ, KENNETH E (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
Last Name:BERKOVITZ
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:PO BOX 2090, 525 E. MARKET STREET
Mailing Address - Street 2:SUMMA PHYSICIANS INC.
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44309-2090
Mailing Address - Country:US
Mailing Address - Phone:330-996-8603
Mailing Address - Fax:330-996-8695
Practice Address - Street 1:95 ARCH STREET
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1437
Practice Address - Country:US
Practice Address - Phone:330-376-7000
Practice Address - Fax:330-376-1066
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061657B207RC0000X
OH35061657207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0843770Medicaid
OHE92773Medicare UPIN
E92773Medicare UPIN
OH0843770Medicaid
OH0693725Medicare PIN