Healthcare Provider Details

I. General information

NPI: 1124089107
Provider Name (Legal Business Name): MARK P BERLAND DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S POTOMAC ST SUITE 135
AURORA CO
80012-5455
US

IV. Provider business mailing address

1550 S POTOMAC ST SUITE 135
AURORA CO
80012-5455
US

V. Phone/Fax

Practice location:
  • Phone: 303-369-1019
  • Fax: 303-369-1062
Mailing address:
  • Phone: 303-369-1019
  • Fax: 303-369-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number20912
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: