Provider Demographics
NPI:1932144532
Name:BERMAN, KASEY REEVES (MD)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:REEVES
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:LOREN
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:410 MALL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4869
Mailing Address - Country:US
Mailing Address - Phone:912-472-0314
Mailing Address - Fax:912-472-0315
Practice Address - Street 1:410 MALL BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4869
Practice Address - Country:US
Practice Address - Phone:912-472-0314
Practice Address - Fax:912-472-0315
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA365255558AMedicaid
GA365255558EMedicaid