=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053473611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOUREDDINE BERKA PH.D., D(ABHI)
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2041 GEORGIA AVE NW SUITE 4B39
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20060-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-865-4337
-----------------------------------------------------
Fax | 202-865-4338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 SIMCOE CIRCLE SW
-----------------------------------------------------
City | CALGARY
-----------------------------------------------------
State | ALBERTA
-----------------------------------------------------
Zip | T3H4S6
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone | 403-680-5355
-----------------------------------------------------
Fax | 403-685-5526
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------