Healthcare Provider Details

I. General information

NPI: 1568428522
Provider Name (Legal Business Name): STEVEN MARC BERLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 OSLER DR SUITE 205
TOWSON MD
21204-7673
US

IV. Provider business mailing address

1205 YORK RD STE 12
LUTHERVILLE TIMONIUM MD
21093-6211
US

V. Phone/Fax

Practice location:
  • Phone: 410-828-8077
  • Fax: 410-828-8077
Mailing address:
  • Phone: 410-828-8077
  • Fax: 410-828-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0022092
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier478621100
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: