Provider Demographics
NPI:1649245085
Name:BERLET, MATTHEW HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:HOWARD
Last Name:BERLET
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:PO BOX 403444
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3444
Mailing Address - Country:US
Mailing Address - Phone:813-348-6951
Mailing Address - Fax:813-348-6999
Practice Address - Street 1:4516 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2732
Practice Address - Country:US
Practice Address - Phone:813-348-6951
Practice Address - Fax:813-348-6999
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63918174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376069300Medicaid
FL300060749OtherRR MEDICARE
FL300060749OtherRR MEDICARE
FLE76201Medicare UPIN