Healthcare Provider Details

I. General information

NPI: 1184819237
Provider Name (Legal Business Name): ROBERT SOLOMON BERCOVITCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 ZION AVE
SAN DIEGO CA
92120-2507
US

IV. Provider business mailing address

20 YORK ST CB 2041
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 877-236-0333
  • Fax: 760-510-5495
Mailing address:
  • Phone: 203-688-4748
  • Fax: 203-688-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA102916
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA102916
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA102916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: