Provider Demographics
NPI:1184619041
Name:OPPONG, BERNARD K (DO)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:K
Last Name:OPPONG
Suffix:
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:PO BOX 76621
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-6500
Mailing Address - Country:US
Mailing Address - Phone:727-287-6300
Mailing Address - Fax:
Practice Address - Street 1:844 MINERVA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5045
Practice Address - Country:US
Practice Address - Phone:614-844-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340054010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0886993Medicaid
OH000000319616OtherBCBS GREENFIELD
OHF37727Medicare UPIN
OH0886993Medicaid
OHP00625605Medicare PIN
OH4108525Medicare PIN
OHOP7239531Medicare PIN