Basic Information
| Provider Information | |||||||||
| NPI: | 1275554776 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERGER | ||||||||
| FirstName: | MELVIN | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3605 WARRENSVILLE CENTER RD | ||||||||
| Address2: | 1ST FL, MSC9152 | ||||||||
| City: | SHAKER HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162866299 | ||||||||
| FaxNumber: | 2162866341 | ||||||||
| Practice Location | |||||||||
| Address1: | 11100 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441061716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168447700 | ||||||||
| FaxNumber: | 2162866341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 09/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0201X | 35-050886 | ND | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology |
ID Information
| ID | Type | State | Issuer | Description | 0011201010003 | 01 | PA | PA MEDICAID | OTHER | 000000221094 | 01 | OH | UNISON | OTHER | 000000525881 | 01 | OH | ANTHEM | OTHER | 0562958 | 05 | OH | MEDICAID | 10025555600 | 01 | NE | NE MEDICAID | OTHER | 363425 | 01 | OH | WELLCARE | OTHER | 738034 | 01 | OH | BUCKEYE | OTHER | 0562958 | 01 | OH | BCMH | OTHER | P00412298 | 01 | OH | RAILROAD MEDICARE | OTHER | 000000028073 | 01 | OH | ANTHEM | OTHER | 639478 | 01 | OH | AETNA | OTHER | 370001899 | 01 | OH | RAILROAD MEDICARE | OTHER | 3810012322 | 01 | WV | WV MEDICAID | OTHER |