Provider Demographics
NPI:1306818539
Name:BERDING, HERBERT C JR (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:C
Last Name:BERDING
Suffix:JR
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 1:1970 ROANOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6404
Mailing Address - Country:US
Mailing Address - Phone:540-982-2463
Mailing Address - Fax:540-983-1090
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:540-983-1090
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101043665207L00000X, 207L00000X
CT042714207L00000X
GA026454207L00000X
IL036-112764207L00000X
ME016662207L00000X
NMMD-2005-0638207L00000X
NY234694207L00000X
VT042-0011000207L00000X
WAMD00046563207L00000X
WI47452-020207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D91467Medicare UPIN
IAI14801Medicare PIN