Provider Demographics
NPI:1942495239
Name:MARK P BERLAND, DO, PC
Entity Type:Organization
Organization Name:MARK P BERLAND, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:BERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-369-1019
Mailing Address - Street 1:1550 S POTOMAC ST
Mailing Address - Street 2:SUITE 135
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5455
Mailing Address - Country:US
Mailing Address - Phone:303-360-1019
Mailing Address - Fax:303-369-1062
Practice Address - Street 1:1550 S POTOMAC ST
Practice Address - Street 2:SUITE 135
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5455
Practice Address - Country:US
Practice Address - Phone:303-360-1019
Practice Address - Fax:303-369-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20912207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04005500Medicaid
COC1832Medicare PIN