Provider Demographics
NPI:1538149745
Name:BERLINER, JESSICA (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BERLINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WELWYN PL
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-8111
Mailing Address - Country:US
Mailing Address - Phone:804-363-8170
Mailing Address - Fax:804-282-3744
Practice Address - Street 1:3 WELWYN PL
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-8111
Practice Address - Country:US
Practice Address - Phone:804-363-8170
Practice Address - Fax:804-282-3744
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012247892085N0700X, 2085N0904X, 2085B0100X, 2085P0229X, 2085U0001X, 2085R0204X, 2085R0202X
CAC1352112085R0202X
GA1020172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA224564OtherANTHEM
VA1538149745Medicaid
VA224564OtherANTHEM
VA300112493Medicare PIN