Provider Demographics
NPI:1750451035
Name:BERKOWITZ, NEIL MALCOLM (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:MALCOLM
Last Name:BERKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10297 SCRIPPS TRAIL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2307
Mailing Address - Country:US
Mailing Address - Phone:858-586-0443
Mailing Address - Fax:858-586-0563
Practice Address - Street 1:10297 SCRIPPS TRAIL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2307
Practice Address - Country:US
Practice Address - Phone:858-586-0443
Practice Address - Fax:858-586-0563
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA40554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A29146Medicare UPIN