Provider Demographics
NPI:1639181423
Name:BERLIN, GERALD (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:BERLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 STATE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6652
Mailing Address - Country:US
Mailing Address - Phone:207-990-0928
Mailing Address - Fax:207-945-4354
Practice Address - Street 1:404 STATE ST STE 200
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6652
Practice Address - Country:US
Practice Address - Phone:207-990-0928
Practice Address - Fax:207-945-4354
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1645207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME323840099Medicaid
MEMM8896Medicare PIN
MEF14788Medicare UPIN