MEDICARE: DR. BRAD DAVID BERMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0006X	Developmental - Behavioral Pediatrics Physician	G57424	CA

General Provider Information

NPI Number	:	1184609653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD DAVID BERMAN MD

Provider Business Mailing Address
First Line	:	3021 CITRUS CIR STE 240
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-2691
Country	:	US
Telephone Number	:	925-279-3480
Fax Number	:	925-279-3485

Provider Business Practice Location Address
First Line	:	3021 CITRUS CIR STE 240
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-2691
Country	:	US
Telephone Number	:	925-279-3480
Fax Number	:	925-279-3485

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	07/17/2007

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