Provider Demographics
NPI:1366423170
Name:BERMAN, LORRAINE MAYER-WOLPERT (MD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:MAYER-WOLPERT
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORRAINE
Other - Middle Name:MAYER
Other - Last Name:WOLPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5 FIRST VILLAGE DR
Mailing Address - Street 2:P.O. BOX 2000
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8724
Mailing Address - Country:US
Mailing Address - Phone:910-295-6831
Mailing Address - Fax:910-235-2539
Practice Address - Street 1:5 FIRST VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8724
Practice Address - Country:US
Practice Address - Phone:910-295-6831
Practice Address - Fax:910-235-2539
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-014492086S0129X
VA01012408812086S0129X
MA1607222086S0129X
CT0379302086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0129691Medicaid
A32165Medicare ID - Type Unspecified
MA0129691Medicaid