Provider Demographics
NPI:1164678819
Name:SCOTT A. BERKMAN, MD, PLC
Entity Type:Organization
Organization Name:SCOTT A. BERKMAN, MD, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-227-1178
Mailing Address - Street 1:9935-D REA ROAD
Mailing Address - Street 2:#276
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1073
Mailing Address - Country:US
Mailing Address - Phone:480-227-1178
Mailing Address - Fax:704-341-7398
Practice Address - Street 1:17332 NEWLANDS CORNER LANE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1073
Practice Address - Country:US
Practice Address - Phone:480-227-1178
Practice Address - Fax:704-341-7398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-001952088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ458928Medicaid