MEDICARE: BERLAND MEDICAL GROUP 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	207Q00000X	Family Medicine Physician	ME83967	FL

General Provider Information

NPI Number	:	1376052019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERLAND MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	2410 NORTHSIDE DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33761-2236
Country	:	US
Telephone Number	:	727-499-0356
Fax Number	:	727-781-3312

Provider Business Practice Location Address
First Line	:	11792 LAKE ASTON CT STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-3135
Country	:	US
Telephone Number	:	813-690-0225
Fax Number	:	877-992-6777

Authorized Official
Title or Position	:	OWNER
Name	:	GREGORY A BERLAND
Credential	:	MD
Telephone Number	:	813-690-0225

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	09/26/2017

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