Provider Demographics
NPI:1053310789
Name:BERK, SANDERS HARRIS (MD)
Entity Type:Individual
Prefix:
First Name:SANDERS
Middle Name:HARRIS
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 1:15245 SHADY GROVE RD STE 370
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6237
Mailing Address - Country:US
Mailing Address - Phone:240-246-7414
Mailing Address - Fax:240-477-4364
Practice Address - Street 1:15245 SHADY GROVE RD STE 370
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6237
Practice Address - Country:US
Practice Address - Phone:240-246-7414
Practice Address - Fax:240-477-4364
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0012529207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411741700Medicaid
C62045Medicare UPIN