Healthcare Provider Details

I. General information

NPI: 1891728309
Provider Name (Legal Business Name): ROBERT L. DEBERNARDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE A-81
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE A-81
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-7645
  • Fax:
Mailing address:
  • Phone: 216-444-7645
  • Fax: 216-444-8557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number35084495
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: