Provider Demographics
NPI:1437336724
Name:BERMINGHAM, EDWARD JOHN IV (PA-C)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:BERMINGHAM
Suffix:IV
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PLYMOUTH RD
Mailing Address - Street 2:STE 250
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2366
Mailing Address - Country:US
Mailing Address - Phone:952-593-9818
Mailing Address - Fax:
Practice Address - Street 1:2000 PLYMOUTH RD
Practice Address - Street 2:STE 250
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55305-2366
Practice Address - Country:US
Practice Address - Phone:952-593-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10367363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical