Provider Demographics
NPI:1063490027
Name:BERBERIAN, BRENDA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:JEAN
Last Name:BERBERIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1443
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4320
Mailing Address - Country:US
Mailing Address - Phone:301-656-7660
Mailing Address - Fax:301-656-0634
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1443
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4320
Practice Address - Country:US
Practice Address - Phone:301-656-7660
Practice Address - Fax:301-656-0634
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029682207N00000X
MD0029682207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
513775Medicare ID - Type Unspecified
C89295Medicare UPIN