Provider Demographics
NPI:1912920893
Name:RENIER-BERG, DILETTA MARIE (MD)
Entity type:Individual
Prefix:
First Name:DILETTA
Middle Name:MARIE
Last Name:RENIER-BERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DILETTA
Other - Middle Name:MARIE
Other - Last Name:RENIER-DOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:513-853-4684
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:10500 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4402
Practice Address - Country:US
Practice Address - Phone:513-865-2246
Practice Address - Fax:513-865-5596
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96-124208M00000X
OH35131612208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH614010OtherMEDICARE
OH0261173Medicaid
NMJ8213Medicaid