Provider Demographics
NPI:1972559367
Name:BERMAN, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-742-7338
Mailing Address - Fax:603-740-9528
Practice Address - Street 1:15 OLD ROLLINSFORD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2868
Practice Address - Country:US
Practice Address - Phone:603-742-7338
Practice Address - Fax:603-740-9528
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-08-22
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Provider Licenses
StateLicense IDTaxonomies
NH9669207Q00000X
MEMD18166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075878Medicaid
ME1972559367Medicaid
NHG27674Medicare UPIN
ME1972559367Medicaid