1518960376 NPI number — DR. PAUL D BERLACHER MD

Table of content: DR. PAUL D BERLACHER MD (NPI 1518960376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518960376 NPI number — DR. PAUL D BERLACHER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERLACHER
Provider First Name:
PAUL
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518960376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2940 N MCCORD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43615-1753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-842-3094
Provider Business Mailing Address Fax Number:
419-842-3048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2940 N MCCORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43615-1753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-842-3094
Provider Business Practice Location Address Fax Number:
419-842-3048
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  35046095B , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 4301084745 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00975134 . This is a "RRMC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0528521 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00711881 . This is a "RRMC" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com