Healthcare Provider Details

I. General information

NPI: 1144289877
Provider Name (Legal Business Name): SCOTT IRA BERKENBLIT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 PARK CENTER DR STE 410
LAUREL MD
20707-5251
US

IV. Provider business mailing address

4313 ROLAND SPRINGS DR
BALTIMORE MD
21210-2756
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-0383
  • Fax:
Mailing address:
  • Phone: 410-467-5047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0054384
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0054384
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: