=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922092188
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL RICHARD BERMAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2005
-----------------------------------------------------
Last Update Date | 04/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 687 MAIN ST
-----------------------------------------------------
City | BRANFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06405-3612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-488-8306
-----------------------------------------------------
Fax | 203-481-0287
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 PROSPECT CT
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06525-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-387-8888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 017989
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------