Provider Demographics
NPI:1578789301
Name:SANDERS H. BERK, M.D. PA
Entity Type:Organization
Organization Name:SANDERS H. BERK, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:WEIKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-840-2266
Mailing Address - Street 1:19221 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:C-12
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-5022
Mailing Address - Country:US
Mailing Address - Phone:301-840-2266
Mailing Address - Fax:
Practice Address - Street 1:19221 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:C-12
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-5022
Practice Address - Country:US
Practice Address - Phone:301-840-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO12529207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C62045Medicare UPIN