Healthcare Provider Details

I. General information

NPI: 1326650334
Provider Name (Legal Business Name): PAUL BEREZ MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 DEFENSE HWY STE 403
CROFTON MD
21114-2931
US

IV. Provider business mailing address

1684 VILLAGE GRN
CROFTON MD
21114-2059
US

V. Phone/Fax

Practice location:
  • Phone: 410-570-7455
  • Fax: 667-307-4909
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL BEREZ
Title or Position: OWNER
Credential:
Phone: 703-307-7543