Provider Demographics
NPI:1861476368
Name:BERASI, CARL C III (DO)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:C
Last Name:BERASI
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-1329
Mailing Address - Country:US
Mailing Address - Phone:614-890-6555
Mailing Address - Fax:614-823-7075
Practice Address - Street 1:70 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-1329
Practice Address - Country:US
Practice Address - Phone:614-890-6555
Practice Address - Fax:614-823-7075
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003025B207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0558418Medicaid
OH0558418Medicaid
OHBE0550865Medicare PIN