Provider Demographics
NPI:1316043037
Name:BERLIN, ALAN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JOSEPH
Last Name:BERLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 MITYLENE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3548
Mailing Address - Country:US
Mailing Address - Phone:334-244-7874
Mailing Address - Fax:334-274-0174
Practice Address - Street 1:214 MITYLENE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3548
Practice Address - Country:US
Practice Address - Phone:334-244-7874
Practice Address - Fax:334-274-0174
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10816208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000011621Medicaid
AL000011621Medicare ID - Type Unspecified
C70588Medicare UPIN