Provider Demographics
NPI:1407084544
Name:BERENBERG, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BERENBERG
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 1:1201W MAIN ST 100
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3105
Mailing Address - Country:US
Mailing Address - Phone:203-573-4803
Mailing Address - Fax:203-573-4805
Practice Address - Street 1:1201 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3105
Practice Address - Country:US
Practice Address - Phone:203-573-4803
Practice Address - Fax:203-573-4805
Is Sole Proprietor?:No
Enumeration Date:2009-06-28
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054581207W00000X, 207WX0107X
PAMT195199390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program