Mark Berbaum MD Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

35056279B Issued in OH

Legal business name

MARK BERBAUM MD INC

Practice address

4527 Everhard Rd NW
Canton, OH 44718

Phone

(330) 966-3111

Fax

(330) 966-1416

NPI assigned

May 28, 2008

Last updated

May 28, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark William Berbaum, MDNPI 1285651141

Title

Owner

Phone

(330) 966-3111

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark William Berbaum, MD

  • Dermatology Physician
  • Canton, OH
  • NPI 1285651141
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211932800000",
    "number": "1750549747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4527 EVERHARD RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "44718",
            "telephone_number": "330-966-3111",
            "fax_number": "330-966-1416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4527 EVERHARD RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "44718",
            "telephone_number": "330-966-3111",
            "fax_number": "330-966-1416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK BERBAUM MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-28",
        "last_updated": "2008-05-28",
        "status": "A",
        "authorized_official_last_name": "BERBAUM",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-966-3111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OH",
            "license": "35056279B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000139234",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "070008885",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kirsten Marconi-Hutkay, AUD
• Tricia K Mares
• Margaret B Shaley Child Health Clinic Inc
• Calsandra A Marinchick, CCHW
• Kelly A Marinis, LISW-S
• Mark R. Grubb, MD, Inc.
• Mark R. Grubb, MD, Inc.
• Allison Markham-Strahsburg
• Stefania Markou, DO
• Marilyn Renee Marks Davis, DDS

• Dermatology Physician in Canton, OH
• Providers in Canton, OH by specialty
• Dermatology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.