Provider Demographics
NPI:1730102252
Name:BERMAN, DONALD EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EUGENE
Last Name:BERMAN
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 1:1434 WILLIAMSBRIDGE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2507
Mailing Address - Country:US
Mailing Address - Phone:718-618-0401
Mailing Address - Fax:347-479-1303
Practice Address - Street 1:2015 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4303
Practice Address - Country:US
Practice Address - Phone:718-299-7295
Practice Address - Fax:718-299-6797
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146081174400000X, 207R00000X
IN01065782A207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200986160Medicaid
NY117056OtherMVP HEALTHCARE
IN26-3086555OtherREID PHYSICIAN ASSOCIATES, INC.
IN000000937577OtherANTHEM PROVIDER NUMBER
NY58A88OtherEMPIRE BLUE CROSS BLUE SH
NY217019OtherMVP HEALTHCARE
NY58A88OtherEMPIRE BLUE CROSS BLUE SH
IN815500092Medicare PIN
NY58A881Medicare UPIN
NY58A88OtherEMPIRE BLUE CROSS BLUE SH