Provider Demographics
NPI:1154399418
Name:BERLIN, COREY DREW (MD)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:DREW
Last Name:BERLIN
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 1:2709 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6462
Mailing Address - Country:US
Mailing Address - Phone:919-876-7692
Mailing Address - Fax:919-876-7692
Practice Address - Street 1:2709 BLUE RIDGE RD
Practice Address - Street 2:SUITE 320
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6462
Practice Address - Country:US
Practice Address - Phone:919-876-7692
Practice Address - Fax:919-876-7692
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600457207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8915278Medicaid
NC15278OtherBCBS
NCP00639170OtherRR MEDICARE
NCP00639170OtherRR MEDICARE
NC8915278Medicaid
NC2223090BMedicare PIN