Healthcare Provider Details

I. General information

NPI: 1558551762
Provider Name (Legal Business Name): BRENDA J BERBERIAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5530 WISCONSIN AVENUE SUITE 1443
CHEVY CHASE MO
20815-4320
US

IV. Provider business mailing address

5530 WISCONSIN AVENUE SUITE 1443
CHEVY CHASE MO
20815-4320
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-7660
  • Fax: 301-656-0634
Mailing address:
  • Phone: 301-656-7660
  • Fax: 301-656-0634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0029682
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberD0029682
License Number StateMD

VIII. Authorized Official

Name: BRENDA J BERBERIAN
Title or Position: CEO
Credential: MD LLC
Phone: 301-656-7660