MEDICARE: SCOTT BERMAN MD

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	207V00000X	Obstetrics & Gynecology Physician	224865	NY
2	207VG0400X	Gynecology Physician	224865	NY
3	207VX0000X	Obstetrics Physician	224865	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093707572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT BERMAN MD

Provider Business Mailing Address
First Line	:	2500 NESCONSET HWY
Second Line	:	BUILDING 12 SUITE 45
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2555
Country	:	US
Telephone Number	:	631-675-9010
Fax Number	:	631-675-9009

Provider Business Practice Location Address
First Line	:	2500 NESCONSET HWY
Second Line	:	BUILDING 12 SUITE 45
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2555
Country	:	US
Telephone Number	:	631-675-9010
Fax Number	:	631-675-9009

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	05/17/2012

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