MEDICARE: MAX MEIR BERMANN M.D.

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	2085R0202X	Diagnostic Radiology Physician	30471	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700612	OTHER	MA	TUFTS HEALTH CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C04737	OTHER	MA	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1346237443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAX MEIR BERMANN M.D.

Provider Business Mailing Address
First Line	:	1153 CENTRE ST
Second Line	:	RADIOLOGY, FAULKNER HOSPITAL
City	:	BOSTON
State	:	MA
Zip	:	02130-3446
Country	:	US
Telephone Number	:	617-983-7090
Fax Number	:	617-983-7091

Provider Business Practice Location Address
First Line	:	1153 CENTRE ST
Second Line	:	RADIOLOGY, FAULKNER HOSPITAL
City	:	BOSTON
State	:	MA
Zip	:	02130-3446
Country	:	US
Telephone Number	:	617-983-7090
Fax Number	:	617-983-7091

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/14/2010

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Directions to “ MAX MEIR BERMANN M.D.” Practice Location

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