MEDICARE: BERLIN PEDIATRIC ASSOCIATES, LLC

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	208000000X	Pediatrics Physician	041963	CT

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	:	1245407352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERLIN PEDIATRIC ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	742 WORTHINGTON RDG
Second Line	:	SUITE A
City	:	BERLIN
State	:	CT
Zip	:	06037-3233
Country	:	US
Telephone Number	:	860-829-7337
Fax Number	:	860-829-2295

Provider Business Practice Location Address
First Line	:	742 WORTHINGTON RDG
Second Line	:	SUITE A
City	:	BERLIN
State	:	CT
Zip	:	06037-3233
Country	:	US
Telephone Number	:	860-829-7337
Fax Number	:	860-829-2295

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. MATTEO JOSEPH LOPREIATO
Credential	:	MD
Telephone Number	:	860-829-7337

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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