Provider Demographics
NPI:1033183744
Name:BERMAN, ROBERT J JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BERMAN
Suffix:JR
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 1:3234 MILLER AVENUE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555
Mailing Address - Country:US
Mailing Address - Phone:931-707-8700
Mailing Address - Fax:931-456-0802
Practice Address - Street 1:3234 MILLER AVENUE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555
Practice Address - Country:US
Practice Address - Phone:931-707-8700
Practice Address - Fax:931-456-0802
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34518208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3899096Medicaid
TN3899096Medicaid