Provider Demographics
NPI:1306831391
Name:BERV, DOUGLAS A (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:BERV
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1890 DIXWELL AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-3122
Mailing Address - Country:US
Mailing Address - Phone:203-407-6444
Mailing Address - Fax:203-407-6442
Practice Address - Street 1:60 WASHINGTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3271
Practice Address - Country:US
Practice Address - Phone:203-407-6400
Practice Address - Fax:203-281-5555
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CT0185952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB38227Medicare UPIN