Provider Demographics
NPI:1497847594
Name:BERMAN, BARRY J (MD)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:J
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 1:44241 15TH ST W STE 305
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5502
Mailing Address - Country:US
Mailing Address - Phone:661-949-5899
Mailing Address - Fax:661-949-5832
Practice Address - Street 1:44241 15TH ST W STE 305
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5502
Practice Address - Country:US
Practice Address - Phone:661-949-5899
Practice Address - Fax:661-949-5832
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45154174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1548226491OtherNPI FOR GROUP
CA00G45154Medicaid
CA00G45154Medicaid