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NPI Code Detail

MEDICARE: SUSAN ELAINE BERNER M.D.

MEDICARE: SUSAN ELAINE BERNER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QG0300XGeriatric Medicine (Family Medicine) Physician35082769OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952384505
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN ELAINE BERNER M.D.
Provider Business Mailing Address
First Line : 1110 OAKWOOD AVE
Second Line :
City : OAKWOOD
State : OH
Zip : 45419-2911
Country : US
Telephone Number : 937-885-7163
Fax Number : 937-567-0670
Provider Business Practice Location Address
First Line : 1110 OAKWOOD AVE
Second Line :
City : OAKWOOD
State : OH
Zip : 45419-2911
Country : US
Telephone Number : 937-885-7163
Fax Number : 937-567-0670
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2005
Last Update Date : 07/17/2019

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Directions to “ SUSAN ELAINE BERNER M.D.” Practice Location

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