MEDICARE: ERIC M BERSHAD MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084V0102X	Vascular Neurology Physician	83425	SC
2	2084V0102X	Vascular Neurology Physician	2020-00211	NC
3	2084V0102X	Vascular Neurology Physician	53649	KY
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	M9160	TX
5	2084V0102X	Vascular Neurology Physician	0101268754	VA
6	2084A2900X	Neurocritical Care Physician	M9160	TX
7	2084N0400X	Neurology Physician	M9160	TX
8	2084N0400X	Neurology Physician	01083259A	IN
9	2084V0102X	Vascular Neurology Physician	59616	AZ
10	2084V0102X	Vascular Neurology Physician	M9160	TX
11	2084V0102X	Vascular Neurology Physician	85085	GA
12	2084V0102X	Vascular Neurology Physician	ME144173	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000374357	OTHER	OH	ANTHEM

NPI Number	:	1235109083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC M BERSHAD MD

Provider Business Mailing Address
First Line	:	1 BAYLOR PLZ # NB-302
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3411
Country	:	US
Telephone Number	:	713-798-8472
Fax Number	:	713-798-3091

Provider Business Practice Location Address
First Line	:	1 BAYLOR PLZ # NB-302
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3411
Country	:	US
Telephone Number	:	713-798-8472
Fax Number	:	713-798-3091

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	03/25/2021

6621 FANNIN ST A1170 , PEDIATRIC HOUSE STAFF OFFICE
HOUSTON, TX
77030-3411

Practice Phone: 713-798-4951
Practice Fax: