Provider Demographics
NPI:1477553642
Name:BERLIN, BERT B (MD)
Entity Type:Individual
Prefix:DR
First Name:BERT
Middle Name:B
Last Name:BERLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 416
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-947-8500
Mailing Address - Fax:860-524-8643
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 416
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-947-8500
Practice Address - Fax:860-524-8643
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT010699208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0S0304OtherHEALTH NET
CT076037OtherCONNECTICARE
CTP1096759OtherOXFORD
CT010010699CT01OtherANTHEM BCBS
CT10567OtherHEALTH NEW ENGLAND
CT4413115002OtherCIGNA
CT2053926OtherAETNA
MA3164926Medicaid
CT0S0304OtherHEALTH NET