Provider Demographics
NPI:1013266774
Name:VEREB, BRIAN LEE (NP-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
Last Name:VEREB
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3562 RIDGE PARK DR
Mailing Address - Street 2:STE. A
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9294
Mailing Address - Country:US
Mailing Address - Phone:330-664-0767
Mailing Address - Fax:330-665-4190
Practice Address - Street 1:3562 RIDGE PARK DR
Practice Address - Street 2:STE. A
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9294
Practice Address - Country:US
Practice Address - Phone:330-664-0767
Practice Address - Fax:330-665-4190
Is Sole Proprietor?:No
Enumeration Date:2012-09-09
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13794-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH0077984Medicaid
OH0077984Medicaid