MEDICARE: BERMANN AUGUSTIN

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	246ZC0007X	Surgical Assistant	20-292	WI
2	363A00000X	Physician Assistant	001457-P.A.	PR

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	:	1639787914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERMANN AUGUSTIN

Provider Business Mailing Address
First Line	:	3303 S KESWICK PLZ
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1677
Country	:	US
Telephone Number	:	267-461-4340
Fax Number	:

Provider Business Practice Location Address
First Line	:	3303 S KESWICK PLZ
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1677
Country	:	US
Telephone Number	:	267-461-4340
Fax Number	:

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

Provider Enumeration Date	:	07/22/2020
Last Update Date	:	11/06/2022

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Directions to “ BERMANN AUGUSTIN ” Practice Location

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