Provider Demographics
NPI:1558551762
Name:BRENDA J BERBERIAN MD LLC
Entity Type:Organization
Organization Name:BRENDA J BERBERIAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERBERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD LLC
Authorized Official - Phone:301-656-7660
Mailing Address - Street 1:5530 WISCONSIN AVENUE
Mailing Address - Street 2:SUITE 1443
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MO
Mailing Address - Zip Code:20815-4320
Mailing Address - Country:US
Mailing Address - Phone:301-656-7660
Mailing Address - Fax:301-656-0634
Practice Address - Street 1:5530 WISCONSIN AVENUE
Practice Address - Street 2:SUITE 1443
Practice Address - City:CHEVY CHASE
Practice Address - State:MO
Practice Address - Zip Code:20815-4320
Practice Address - Country:US
Practice Address - Phone:301-656-7660
Practice Address - Fax:301-656-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029682207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
513775Medicare UPIN