MEDICARE: JEFFREY ALAN BERENSON MD

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	207R00000X	Internal Medicine Physician	G39574	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00872335	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G395740	OTHER	CA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902828619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY ALAN BERENSON MD

Provider Business Mailing Address
First Line	:	3536 MENDOCINO AVE
Second Line	:	SUITE 200
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3634
Country	:	US
Telephone Number	:	707-575-6049
Fax Number	:	707-937-1061

Provider Business Practice Location Address
First Line	:	45081 LITTLE LAKE STREET
Second Line	:
City	:	MENDOCINO
State	:	CA
Zip	:	95460
Country	:	US
Telephone Number	:	707-937-1055
Fax Number	:	707-937-1061

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	03/25/2021

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