Provider Demographics
NPI:1619191517
Name:JEFFREY A. BERMAN MD INC
Entity Type:Organization
Organization Name:JEFFREY A. BERMAN MD INC
Other - Org Name:JEFFREY A MERMAN MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:HELENE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HANADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-553-5633
Mailing Address - Street 1:2080 CENTURY PARK EAST # 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067
Mailing Address - Country:US
Mailing Address - Phone:310-553-5633
Mailing Address - Fax:310-553-2469
Practice Address - Street 1:2080 CENTURY PARK EAST # 305
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067
Practice Address - Country:US
Practice Address - Phone:310-553-5633
Practice Address - Fax:310-553-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42512207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A92343Medicare UPIN
CAG42512Medicare ID - Type Unspecified