Provider Demographics
NPI:1215096748
Name:EBERT, DANIEL M (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:EBERT
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 1:1485 E WESTERN RESERVE RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3252
Mailing Address - Country:US
Mailing Address - Phone:330-884-2061
Mailing Address - Fax:330-884-2060
Practice Address - Street 1:1485 E WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3252
Practice Address - Country:US
Practice Address - Phone:330-884-2061
Practice Address - Fax:330-884-2060
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350762082086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2236931Medicaid
OH4044552Medicare ID - Type Unspecified
OH2236931Medicaid