Provider Demographics
NPI:1316924749
Name:BER, DORON J (MD)
Entity type:Individual
Prefix:
First Name:DORON
Middle Name:J
Last Name:BER
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 1:196 WATERFORD PKWY S STE 305B
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1245
Mailing Address - Country:US
Mailing Address - Phone:860-536-2995
Mailing Address - Fax:860-574-9170
Practice Address - Street 1:196 WATERFORD PKWY S STE 305B
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1245
Practice Address - Country:US
Practice Address - Phone:860-536-2995
Practice Address - Fax:860-574-9170
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033522207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001335224Medicare ID - Type Unspecified
F75168Medicare UPIN
030000088Medicare ID - Type Unspecified