MEDICARE: GREGORY MARK EBERHART MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35074110	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	C09331561	OTHER		MEDICARE GROUP PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0069964001	OTHER	CIGNA
2	D7411004	OTHER	HUMANA
3	G23791	OTHER	NATIONAL PROVIDER ID
4	522374873	OTHER	TAX ID
5	10790951	OTHER	CAQH
6	2032058	OTHER	AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	522374873029	OTHER	CARESOURCE
9	36D1007721	OTHER	CLIA
11	1201765	OTHER	UHC
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	000000244980	OTHER	ANTHEM

General Provider Information

NPI Number	:	1841278926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY MARK EBERHART MD

Provider Business Mailing Address
First Line	:	PO BOX 933432
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0039
Country	:	US
Telephone Number	:	937-641-5072
Fax Number	:	937-641-6129

Provider Business Practice Location Address
First Line	:	3333 W TECH RD STE 220
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-0956
Country	:	US
Telephone Number	:	937-885-4475
Fax Number	:	937-885-3670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	03/05/2026

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Directions to “ GREGORY MARK EBERHART MD” Practice Location

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