Provider Demographics
NPI:1508990441
Name:BERDICH, ALLA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ALLA
Middle Name:
Last Name:BERDICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18671 COLLINS AVE
Mailing Address - Street 2:APT 703
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2478
Mailing Address - Country:US
Mailing Address - Phone:305-705-0801
Mailing Address - Fax:954-983-5086
Practice Address - Street 1:4700 SHERIDAN ST
Practice Address - Street 2:SUITE R
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3420
Practice Address - Country:US
Practice Address - Phone:954-983-5330
Practice Address - Fax:954-983-5086
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME892582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52324Medicare ID - Type Unspecified
FLD15347Medicare UPIN