Provider Demographics
NPI:1609970805
Name:BERK, ROBERT L (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:BERK
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 1:540 WOODBOURNE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1856
Mailing Address - Country:US
Mailing Address - Phone:215-750-6611
Mailing Address - Fax:
Practice Address - Street 1:6 EARLIN AVE STE 290
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015-1780
Practice Address - Country:US
Practice Address - Phone:609-537-7200
Practice Address - Fax:609-896-3986
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045704L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014846240005Medicaid
PA0014846240005Medicaid
PA714206LL7Medicare ID - Type Unspecified