Individual
MR. MARK WILLIAM BERBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4527 EVERHARD RD NW, CANTON, OH 44718
(330) 966-3111
(330) 966-1416
Mailing address
4527 EVERHARD RD NW, CANTON, OH 44718
(330) 966-3111
(330) 966-1416
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35056279B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000139234
ANTHEM BCBS
—
01
—
070008885
RAILROAD MEDICARE
—
01
—
34180382300
WORKERS COMPENSATION
—
Enumeration date
07/16/2006
Last updated
02/20/2013
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