Provider Demographics
NPI:1295026110
Name:MICHAEL BERARD MD & ASSOCIATES PC
Entity Type:Organization
Organization Name:MICHAEL BERARD MD & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:BERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-864-2100
Mailing Address - Street 1:7305 BALTIMORE AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3234
Mailing Address - Country:US
Mailing Address - Phone:301-864-2100
Mailing Address - Fax:301-864-5057
Practice Address - Street 1:7305 BALTIMORE AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3234
Practice Address - Country:US
Practice Address - Phone:301-864-2100
Practice Address - Fax:301-864-5057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD26287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB94317Medicare UPIN