Provider Demographics
NPI:1124051768
Name:NAYFACK, BERT (MD)
Entity type:Individual
Prefix:DR
First Name:BERT
Middle Name:
Last Name:NAYFACK
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 1:217 UPTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1839
Mailing Address - Country:US
Mailing Address - Phone:301-424-1490
Mailing Address - Fax:
Practice Address - Street 1:201 N CHARLES ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4102
Practice Address - Country:US
Practice Address - Phone:410-576-9191
Practice Address - Fax:410-576-9257
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00236942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD185131400Medicaid