Provider Demographics
NPI:1366459877
Name:BERARD, MICHAEL JEROME (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JEROME
Last Name:BERARD
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 1:7305 BALTIMORE AVE
Mailing Address - Street 2:#107
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740
Mailing Address - Country:US
Mailing Address - Phone:301-864-2100
Mailing Address - Fax:301-864-5057
Practice Address - Street 1:7305 BALTIMORE AVE
Practice Address - Street 2:#107
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740
Practice Address - Country:US
Practice Address - Phone:301-864-2100
Practice Address - Fax:301-864-5057
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD137231900Medicaid
B94317Medicare UPIN
MD137231900Medicaid