Provider Demographics
NPI:1033118278
Name:BERK, MARTIN R (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:R
Last Name:BERK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 GREENVILLE AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-7906
Mailing Address - Country:US
Mailing Address - Phone:214-369-3613
Mailing Address - Fax:214-369-6042
Practice Address - Street 1:7150 GREENVILLE AVE STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7906
Practice Address - Country:US
Practice Address - Phone:214-369-3613
Practice Address - Fax:214-369-6042
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1191207RC0000X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060031202OtherRAILROAD
TX118259401Medicaid
TXP00044327OtherRAILROAD
TX060025455OtherRAILROAD
TX83G906OtherMEDICARE PTAN
TX85C475OtherBCBS
TXP00044327OtherRAILROAD
TX060031202OtherRAILROAD
TX118259401Medicaid