MEDICARE: DR. DAVID LIONEL BERMAN DPM

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	213E00000X	Podiatrist	SC001524L	PA
2	213E00000X	Podiatrist	Z5MD00138800	NJ

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
2	122804	OTHER	PA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1902829864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LIONEL BERMAN DPM

Provider Business Mailing Address
First Line	:	4000 EDGMONT AVE
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-2211
Country	:	US
Telephone Number	:	610-874-2422
Fax Number	:	610-874-2491

Provider Business Practice Location Address
First Line	:	4000 EDGMONT AVE
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-2211
Country	:	US
Telephone Number	:	610-874-2422
Fax Number	:	610-874-2491

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	03/04/2013

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