Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R126842 | MD |
NPI | 1013204668 |
---|---|
Provider Name | Mr. David Berman |
First Address | Towson, MD 21286-3330 |
Second Address | Pikesville, MD 21208-6391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2011 |
Last Update Date | 06/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00489152 | STATE OF MD CDS (01) | MD |
219541ZC58 | (02) | MD |
MB2376538 | DEA (01) |