Provider Demographics
NPI:1922092519
Name:OSER, BERYL M (MD)
Entity Type:Individual
Prefix:DR
First Name:BERYL
Middle Name:M
Last Name:OSER
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 1:1885 EDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1046
Mailing Address - Country:US
Mailing Address - Phone:614-397-5254
Mailing Address - Fax:614-502-7023
Practice Address - Street 1:1809 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2207
Practice Address - Country:US
Practice Address - Phone:614-502-7022
Practice Address - Fax:614-502-7023
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037240207Q00000X
OH35.037240207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A75722Medicare UPIN
050427655Medicare ID - Type Unspecified