Healthcare Provider Details

I. General information

NPI: 1861433922
Provider Name (Legal Business Name): JEFFREY M BERMAN M/D/
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 RYDAL RD SUITE 100
RYDAL PA
19046-1711
US

IV. Provider business mailing address

1095 RYDAL RD SUITE 100
RYDAL PA
19046-1711
US

V. Phone/Fax

Practice location:
  • Phone: 267-620-1100
  • Fax: 215-572-1279
Mailing address:
  • Phone: 267-620-1100
  • Fax: 215-572-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD062570L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: