Provider Demographics
NPI:1245407352
Name:BERLIN PEDIATRIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BERLIN PEDIATRIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTEO
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LOPREIATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-829-7337
Mailing Address - Street 1:742 WORTHINGTON RDG
Mailing Address - Street 2:SUITE A
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3233
Mailing Address - Country:US
Mailing Address - Phone:860-829-7337
Mailing Address - Fax:860-829-2295
Practice Address - Street 1:742 WORTHINGTON RDG
Practice Address - Street 2:SUITE A
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-3233
Practice Address - Country:US
Practice Address - Phone:860-829-7337
Practice Address - Fax:860-829-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041963208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001419630Medicaid