Healthcare Provider Details

I. General information

NPI: 1285809756
Provider Name (Legal Business Name): EDWARD R. BERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CHARLOU CIR
ENGLEWOOD CO
80111-1103
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 303-740-8080
  • Fax: 303-740-9328
Mailing address:
  • Phone: 303-493-7000
  • Fax: 303-493-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25046
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: