Healthcare Provider Details

I. General information

NPI: 1154399418
Provider Name (Legal Business Name): COREY DREW BERLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 BLUE RIDGE RD SUITE 320
RALEIGH NC
27607-6462
US

IV. Provider business mailing address

2709 BLUE RIDGE RD SUITE 320
RALEIGH NC
27607-6462
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-7692
  • Fax: 919-876-7692
Mailing address:
  • Phone: 919-876-7692
  • Fax: 919-876-7692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number9600457
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: