Healthcare Provider Details

I. General information

NPI: 1164778361
Provider Name (Legal Business Name): CHIRAG A BERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST SURGERY SERVICE
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

3200 VINE ST SURGERY SERVICE
CINCINNATI OH
45220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-3100
  • Fax: 513-475-6470
Mailing address:
  • Phone: 513-861-3100
  • Fax: 513-475-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number35.125271
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.125271
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number35.125271
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: