Provider Demographics
NPI:1518068097
Name:BERKUN, DAVID MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARTIN
Last Name:BERKUN
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 1:30 BUXTON FARMS ROAD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1224
Mailing Address - Country:US
Mailing Address - Phone:203-322-3221
Mailing Address - Fax:203-322-2389
Practice Address - Street 1:30 BUXTON FARMS ROAD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1224
Practice Address - Country:US
Practice Address - Phone:203-322-3221
Practice Address - Fax:203-322-2389
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031344208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics