Basic Information
| Provider Information | |||||||||
| NPI: | 1932291895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERBECK | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 ARCH ST | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302531800 | ||||||||
| FaxNumber: | 3302533955 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 ARCH ST | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302531800 | ||||||||
| FaxNumber: | 3302533955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 10/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 35046964V | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 0608999 | 05 | OH | MEDICAID | VE9259851 | 01 | OH | MEDICARE ID | OTHER | 0572353 | 01 | OH | MEDICARE ID | OTHER |