Provider Demographics
NPI:1043604721
Name:BERLIN, PETER MORRIS JR
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MORRIS
Last Name:BERLIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:ATTN: BH MALONE HOME PROGRAM
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559
Mailing Address - Country:US
Mailing Address - Phone:907-543-2740
Mailing Address - Fax:907-543-6729
Practice Address - Street 1:839 CHIEF EDDIE HOFFMAN HWY
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-543-2740
Practice Address - Fax:907-543-6729
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK7164641OtherDRIVER LICENSE
AK1020986Medicaid