Provider Demographics
NPI:1124061247
Name:BERMAN, BRIAN M
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:BERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64380
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4380
Mailing Address - Country:US
Mailing Address - Phone:410-328-6792
Mailing Address - Fax:410-328-8726
Practice Address - Street 1:29 S PACA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1771
Practice Address - Country:US
Practice Address - Phone:410-328-6792
Practice Address - Fax:410-328-8726
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23907174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD43700Medicare UPIN