Healthcare Provider Details

I. General information

NPI: 1760167977
Provider Name (Legal Business Name): MEAGAN-HELEN HENDERSON BERG MDCM (MD)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 09/27/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 GOVERNOR'S PLACE BLVD DAYTON SKIN CARE, ATTN: IRINA LACHUGINA
DAYTON OH
45409
US

IV. Provider business mailing address

3025 GOVERNOR'S PLACE BLVD DAYTON SKIN CARE, ATTN: IRINA LACHUGINA
DAYTON OH
45409
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-5567
  • Fax: 937-293-5568
Mailing address:
  • Phone: 937-293-5567
  • Fax: 937-293-5568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.147813
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: