Healthcare Provider Details

I. General information

NPI: 1467437392
Provider Name (Legal Business Name): STEVEN GRAEME-IAN BERLIN HEALTH SERVICES TECH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 LEMAY AVE APT. A
BUZZARDS BAY MA
02542-1549
US

IV. Provider business mailing address

5450 LEMAY AVE APT. A
BUZZARDS BAY MA
02542-1549
US

V. Phone/Fax

Practice location:
  • Phone: 508-563-7894
  • Fax:
Mailing address:
  • Phone: 508-563-7894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: