Provider Demographics
NPI:1902847999
Name:NEIBERGER, RICHARD E (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:NEIBERGER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:EUGENE
Other - Last Name:NEIBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:352-273-9180
Mailing Address - Fax:352-392-7107
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-9180
Practice Address - Fax:352-392-7107
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1382822080P0210X
FLME535402080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048900000Medicaid
FL048900000Medicaid
A60221Medicare UPIN
FL68462Medicare ID - Type Unspecified