Provider Demographics
NPI:1215441696
Name:BERKOVITS, DOVID PINCHUS
Entity type:Individual
Prefix:
First Name:DOVID
Middle Name:PINCHUS
Last Name:BERKOVITS
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 1:6808 CHIPPEWA DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1435
Mailing Address - Country:US
Mailing Address - Phone:410-406-7951
Mailing Address - Fax:443-648-9001
Practice Address - Street 1:305 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-5313
Practice Address - Country:US
Practice Address - Phone:410-406-7951
Practice Address - Fax:443-648-9001
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD777536900Medicaid