Provider Demographics
NPI:1356301477
Name:BERMAN, JOEL (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:BERMAN
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:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:935 GARDENIA DR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-4806
Practice Address - Country:US
Practice Address - Phone:610-368-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1133232085R0202X, 2085R0202X
DEC1-00035762085R0202X
MDD459922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300118834OtherRAILROAD MEDICARE #
FL007393800Medicaid
FLP01126043OtherRR MEDICARE
FLP01126045OtherRR MEDICARE
300118834OtherRAILROAD MEDICARE #
FLGU579YMedicare PIN
DE0000346701Medicaid
FL007393800Medicaid
FLP01126043OtherRR MEDICARE
DE006254X70Medicare PIN