Provider Demographics
NPI:1548369606
Name:TVERBERG, DAVID RITLAND (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RITLAND
Last Name:TVERBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-4704
Mailing Address - Country:US
Mailing Address - Phone:507-455-7644
Mailing Address - Fax:507-455-7662
Practice Address - Street 1:610 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4704
Practice Address - Country:US
Practice Address - Phone:507-451-2630
Practice Address - Fax:507-455-8133
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN334492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3K744TVOtherBLUE CROSS
MN269000246OtherMEDICARE PTAN
MN689805000Medicaid
MNHP18407OtherHEALTH PARTNERS
MN15-20385OtherUNITED BEHAVIORAL HEALTH
MN3K744TVOtherBLUE CROSS