Healthcare Provider Details

I. General information

NPI: 1285816009
Provider Name (Legal Business Name): OTTO N BERNATH MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 DELAWARE AVE
AKRON OH
44303-1301
US

IV. Provider business mailing address

671 DELAWARE AVE
AKRON OH
44303-1301
US

V. Phone/Fax

Practice location:
  • Phone: 330-836-1898
  • Fax: 330-836-1898
Mailing address:
  • Phone: 330-836-1898
  • Fax: 330-836-1898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number25665
License Number StateOH

VIII. Authorized Official

Name: OTTO N BERNATH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-836-1898