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General NPI Number Information
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NPI Number | 1902136823
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Entity Type | Individual
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Provider Name | MAX ROBERT BERDICHEVSKY MD
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Gender | Male
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 200 MEDICAL CENTER DR STE 375
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City | MIDDLETOWN
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State | OH
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Zip | 45005-5180
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Country | US
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Telephone | 513-422-8274
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Fax | 513-217-5762
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Provider Business Mailing Address
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Address Line | 3170 KETTERING BLVD BUILDING B, 3RD FLOOR
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City | MORAINE
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State | OH
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Zip | 45439
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Country | US
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Telephone | 937-991-3188
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Fax | 937-223-9811
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD60340423
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | MD60340423
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 35.132180
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License Number State | OH
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