Provider Demographics
NPI:1700847910
Name:BERMINGHAM, JOHN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BERMINGHAM
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 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:750 RT 73 S
Practice Address - Street 2:SUITE 401
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4145
Practice Address - Country:US
Practice Address - Phone:856-375-1288
Practice Address - Fax:856-375-2325
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB049077207RP1001X
NJMB49077207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1620801Medicaid
E53570Medicare UPIN
NJ1620801Medicaid