Ethan Michael Berke, MD, MPH
Individual provider Active NPI Family Medicine Physician · Lebanon, NH
NPI 1902858855 · NPPES record last updated Oct 10, 2022
Key facts
- NPI
- 1902858855
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 63043 (MN)
- Practice address
- 18 Old Etna Rd
DHMC - Department of Community and Family Medicine
Lebanon, NH 03766 - Phone
- (603) 650-4000
- Fax
- (603) 650-4198
- NPI assigned
- May 17, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63043 | MN | MD | Family Medicine Physician |
| 13084 | NH | MD | Family Medicine Physician |
Interoperability endpoints
- ethan.berke.1@33201.direct.athenahealth.com
- ethan.berke.1@27404.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD00035349 | WA | |
| Family Medicine Physician | 207Q00000X | 13084 | NH | |
| Family Medicine Physician | 207Q00000X | 63043 | MN | Yes |
Addresses
Primary practice location
18 Old Etna Rd
DHMC - Department of Community and Family Medicine
Lebanon, NH 03766
Mailing address
1 Medical Center Dr
DHMC - Department of Community and Family Medicine
Lebanon, NH 03756-1000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1012802 | Medicaid | VT | |
| 30206160 | Medicaid | NH |
Other providers in Lebanon, NH
- Anna Berezhny
- Susan Z Berg
- Kathleen E Berger
- Ruth Elizabeth Berggren
- Lindsay Bergmann
- Norman Bruce Berman
- Monika Anna Bernas
- James Lawrence Bernat
- Joseph A Berndsen
- Julia Bernier
All providers in Lebanon, NH · Family Medicine Physician in New Hampshire
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.