Provider Demographics
NPI:1639367642
Name:BERC SARAFIAN P A
Entity Type:Organization
Organization Name:BERC SARAFIAN P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERC
Authorized Official - Middle Name:
Authorized Official - Last Name:SARAFIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-890-8004
Mailing Address - Street 1:2810 W SAINT ISABEL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6375
Mailing Address - Country:US
Mailing Address - Phone:813-890-8004
Mailing Address - Fax:727-518-0762
Practice Address - Street 1:1920 W BAY DR
Practice Address - Street 2:SUITE 6
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3022
Practice Address - Country:US
Practice Address - Phone:727-584-1344
Practice Address - Fax:727-584-7855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46578225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA1597Medicare PIN
FL4499420001Medicare NSC