Individual
GREGORY MARK EBERHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3333 W TECH RD STE 220, MIAMISBURG, OH 45342-0956
(937) 885-4475
(937) 885-3670
Mailing address
PO BOX 933432, CLEVELAND, OH 44193-0039
(937) 641-5072
(937) 641-6129
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35074110
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000244980
ANTHEM
—
01
—
0069964001
CIGNA
—
01
—
10790951
CAQH
—
01
—
1201765
UHC
—
01
—
2032058
AETNA
—
05
—
2059856
—
OH
05
—
2368834
—
OH
01
—
36D1007721
CLIA
—
01
—
522374873
TAX ID
—
01
—
522374873029
CARESOURCE
—
01
—
C09331561
MEDICARE GROUP PIN
—
01
—
D7411004
HUMANA
—
01
—
G23791
NATIONAL PROVIDER ID
—
Enumeration date
01/09/2006
Last updated
03/05/2026
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