Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 20912 | CO |
NPI | 1124089107 |
---|---|
Provider Name | Dr. Mark P Berland |
First Address | Aurora, CO 80012-5455 |
Second Address | Aurora, CO 80012-5455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 07/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01209121 | (05) | CO |
D23852BE | (02) | CO |