MEDICARE: MARC B. BERZANSKY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A8064	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000810568292	OTHER	CA	PHCS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2315376	OTHER	CA	UNITED
4	020A80640	OTHER	CA	BLUE SHIELD
5	100564	OTHER	CA	HEALTH NET
6	8814849	OTHER	CA	CIGNA
7	MCMG253600	OTHER	CA	WESTERN HEALTH ADVANTAGE
8	20A8064	OTHER	CA	BLUE CROSS
9	7613455	OTHER	CA	AETNA
10	2110598	OTHER	CA	FIRST HEALTH
11	81949	OTHER	CA	INTERPLAN
12	1664061	OTHER	CA	GREAT WEST
13	90134403	OTHER	CA	PACIFICARE

General Provider Information

NPI Number	:	1013020833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC B. BERZANSKY D.O.

Provider Business Mailing Address
First Line	:	911 MORAGA RD
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4579
Country	:	US
Telephone Number	:	925-962-9120
Fax Number	:	510-654-2464

Provider Business Practice Location Address
First Line	:	911 MORAGA RD
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4579
Country	:	US
Telephone Number	:	925-961-9120
Fax Number	:	510-654-2464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	11/13/2009

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