Provider Demographics
NPI:1730305814
Name:BERA, ANJALI SARKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:SARKAR
Last Name:BERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANJALI
Other - Middle Name:
Other - Last Name:SARKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1324 GLORIETTA BLVD
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2311
Mailing Address - Country:US
Mailing Address - Phone:619-435-3468
Mailing Address - Fax:619-435-8248
Practice Address - Street 1:1324 GLORIETTA BLVD
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2311
Practice Address - Country:US
Practice Address - Phone:619-435-3468
Practice Address - Fax:619-435-8248
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39248207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A392480Medicaid
CA00A392480Medicaid
CAA39248Medicare ID - Type Unspecified