MEDICARE: JESSICA BERMAN M.D.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD473688	PA

General Provider Information

NPI Number	:	1134514672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BERMAN M.D.

Provider Business Mailing Address
First Line	:	3400 SPRUCE STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4224
Country	:	US
Telephone Number	:	215-662-2300
Fax Number	:	215-614-0418

Provider Business Practice Location Address
First Line	:	3400 SPRUCE STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4224
Country	:	US
Telephone Number	:	215-662-2300
Fax Number	:	215-614-0418

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

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	01/11/2022

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