Healthcare Provider Details

I. General information

NPI: 1487621777
Provider Name (Legal Business Name): ELIZABETH BERYL KLERMAN MD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2006
Last Update Date: 04/18/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMBRIDGE ST 20TH FL- NEUROLOGY
BOSTON MA
02114-2509
US

IV. Provider business mailing address

533 FRANKLIN ST
CAMBRIDGE MA
02139-2923
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-2424
  • Fax:
Mailing address:
  • Phone: 617-475-5013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number78663
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: