Healthcare Provider Details

I. General information

NPI: 1225249568
Provider Name (Legal Business Name): KATHRYN E BERRYMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 N ORANGE AVE STE 402
ORLANDO FL
32804-5505
US

IV. Provider business mailing address

2415 N ORANGE AVE STE 402
ORLANDO FL
32804-5505
US

V. Phone/Fax

Practice location:
  • Phone: 407-622-0560
  • Fax: 407-622-0563
Mailing address:
  • Phone: 407-622-0560
  • Fax: 407-622-0563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME138628
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME138628
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number2018008440
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberR4943
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberME138628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: