Provider Demographics
NPI:1669431938
Name:BERRY, DANIEL B (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:BERRY
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:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:112 INDEPENDENCE WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-9811
Practice Address - Country:US
Practice Address - Phone:419-483-9000
Practice Address - Fax:419-483-9004
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080403B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00345168OtherMEDICARE RAILROAD
OH2301333Medicaid
G71277Medicare UPIN
OH2301333Medicaid