Provider Demographics
NPI:1124086897
Name:BERGER, MELISSA SUE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SUE
Last Name:BERGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:SUE
Other - Last Name:FROELICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2300 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2541
Mailing Address - Country:US
Mailing Address - Phone:419-228-8500
Mailing Address - Fax:419-228-8700
Practice Address - Street 1:801 MEDICAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-4099
Practice Address - Country:US
Practice Address - Phone:419-222-6622
Practice Address - Fax:419-224-0015
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-002351363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000370280OtherANTHEM
OHPA25331Medicare PIN
OHQ49793Medicare UPIN