Provider Demographics
NPI:1114905692
Name:BERMAN, LARRY JAY (USCG CORPSMAN)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JAY
Last Name:BERMAN
Suffix:
Gender:M
Credentials:USCG CORPSMAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USCGC TAHOMA (WMEC-908)
Mailing Address - Street 2:C/O PNSY BUILDING 170
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03804-5000
Mailing Address - Country:US
Mailing Address - Phone:603-918-8735
Mailing Address - Fax:207-438-6655
Practice Address - Street 1:USCGC TAHOMA (WMEC-908)
Practice Address - Street 2:C/O PNSY BUILDING 170
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03804-5000
Practice Address - Country:US
Practice Address - Phone:603-918-8735
Practice Address - Fax:207-438-6655
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider