Provider Demographics
NPI:1235351040
Name:BERMAN, PERRY A (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:A
Last Name:BERMAN
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 1:321 MALLWYD RD
Mailing Address - Street 2:
Mailing Address - City:MERION STA.
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1410
Mailing Address - Country:US
Mailing Address - Phone:610-667-4616
Mailing Address - Fax:215-893-4388
Practice Address - Street 1:321 MALLWYD RD
Practice Address - Street 2:
Practice Address - City:MERION STA.
Practice Address - State:PA
Practice Address - Zip Code:19066-1410
Practice Address - Country:US
Practice Address - Phone:610-667-4616
Practice Address - Fax:215-893-4388
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009821E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28851Medicare UPIN