Provider Demographics
NPI:1174526305
Name:BERENHOLZ, LEONARD P (MD)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:P
Last Name:BERENHOLZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3893 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4706
Mailing Address - Country:US
Mailing Address - Phone:330-856-4000
Mailing Address - Fax:330-609-9910
Practice Address - Street 1:3893 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4706
Practice Address - Country:US
Practice Address - Phone:330-856-4000
Practice Address - Fax:330-609-9910
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073963B207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2048144Medicaid
OHBE0842401Medicare ID - Type UnspecifiedMEDICARE PROVIDER
OHB39777Medicare UPIN