Provider Demographics
NPI:1962503631
Name:BERMAN, ROGER SYDNEY (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:SYDNEY
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 KING STREET
Mailing Address - Street 2:SUITE 123
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-586-4400
Mailing Address - Fax:413-584-2221
Practice Address - Street 1:241 KING STREET
Practice Address - Street 2:SUITE 123
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-586-4400
Practice Address - Fax:413-584-2221
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1608665Medicaid
MAY35970OtherBLUECROSS
MAU19488Medicare UPIN
MAY35970Medicare ID - Type UnspecifiedMEDICARE