Provider Demographics
NPI:1518903962
Name:BERMAN, MARY DWYER (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DWYER
Last Name:BERMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:PENACOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03303-1402
Mailing Address - Country:US
Mailing Address - Phone:603-753-4302
Mailing Address - Fax:603-753-6213
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-753-4302
Practice Address - Fax:603-753-6213
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH027364-21363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHS89846Medicare UPIN