Healthcare Provider Details

I. General information

NPI: 1013204668
Provider Name (Legal Business Name): DAVID BERMAN CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8209 STEVENSON RD
BALTIMORE MD
21208-1832
US

IV. Provider business mailing address

8209 STEVENSON RD
BALTIMORE MD
21208-1832
US

V. Phone/Fax

Practice location:
  • Phone: 410-365-8714
  • Fax:
Mailing address:
  • Phone: 410-365-8714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR126842
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: