Healthcare Provider Details

I. General information

NPI: 1609853977
Provider Name (Legal Business Name): ALVIN J BERLOT D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1089 ROUTE 390
CRESCO PA
18326
US

IV. Provider business mailing address

RR4 BOX 4479
MOSCOW PA
18444
US

V. Phone/Fax

Practice location:
  • Phone: 570-420-2450
  • Fax: 570-420-2442
Mailing address:
  • Phone: 570-842-0968
  • Fax: 570-842-0968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS005689L
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierOS005689L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: