Provider Demographics
NPI:1689866899
Name:BERMAN, ELLEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:M
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:321 MALLWYD RD
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1410
Mailing Address - Country:US
Mailing Address - Phone:610-667-4617
Mailing Address - Fax:215-893-4388
Practice Address - Street 1:321 MALLWYD RD
Practice Address - Street 2:
Practice Address - City:MERION STATION
Practice Address - State:PA
Practice Address - Zip Code:19066-1410
Practice Address - Country:US
Practice Address - Phone:610-667-4617
Practice Address - Fax:215-893-4388
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012986E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry