Healthcare Provider Details

I. General information

NPI: 1831432426
Provider Name (Legal Business Name): JEREMY BERBERIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2360
US

IV. Provider business mailing address

4755 OGLETOWN STANTON ROAD BOX 6001
NEWARK DE
19718-6001
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-1443
  • Fax: 717-531-4441
Mailing address:
  • Phone: 717-531-1443
  • Fax: 717-531-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberC1-0011708
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: