Healthcare Provider Details

I. General information

NPI: 1669431938
Provider Name (Legal Business Name): DANIEL B BERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 INDEPENDENCE WAY SUITE 110
CLYDE OH
43410-9811
US

IV. Provider business mailing address

PO BOX 378
SANDUSKY OH
44871-0378
US

V. Phone/Fax

Practice location:
  • Phone: 419-483-9000
  • Fax: 419-483-9004
Mailing address:
  • Phone: 419-609-1112
  • Fax: 419-609-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35080403B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: