Healthcare Provider Details

I. General information

NPI: 1790740611
Provider Name (Legal Business Name): ROBERT L. BERLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7092 DISTRIBUTION DR SUITE E
LOUISVILLE KY
40258-2877
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 502-935-9970
  • Fax: 502-935-9577
Mailing address:
  • Phone: 502-489-5730
  • Fax: 502-489-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number31271
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number31271
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: