MEDICARE: MR. PAUL ROBERT BERMAN CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN510473L	PA

General Provider Information

NPI Number	:	1811993645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL ROBERT BERMAN CRNA

Provider Business Mailing Address
First Line	:	2413 FAIRWAY TER
Second Line	:
City	:	WARRINGTON
State	:	PA
Zip	:	18976-2059
Country	:	US
Telephone Number	:	215-491-4566
Fax Number	:

Provider Business Practice Location Address
First Line	:	2413 FAIRWAY TER
Second Line	:
City	:	WARRINGTON
State	:	PA
Zip	:	18976-2059
Country	:	US
Telephone Number	:	215-491-4566
Fax Number	:

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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