Provider Demographics
NPI:1346237443
Name:BERMANN, MAX MEIR (MD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:MEIR
Last Name:BERMANN
Suffix:
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 1:1153 CENTRE ST
Mailing Address - Street 2:RADIOLOGY, FAULKNER HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-983-7090
Mailing Address - Fax:617-983-7091
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:RADIOLOGY, FAULKNER HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-983-7090
Practice Address - Fax:617-983-7091
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA304712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA700612OtherTUFTS HEALTH CARE
MA204706Medicaid
MAC04737OtherBLUE CROSS/BLUE SHIELD
MAC04737Medicare ID - Type Unspecified
MAC04737OtherBLUE CROSS/BLUE SHIELD