Provider Demographics
NPI:1992854392
Name:BERMAN, TARA J (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:J
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:P.O. BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19723-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4000
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:833 CHESTNUT STREET EAST, SUITE 300
Practice Address - Street 2:JEF FACULTY PEDS AND DUPONT CHILDRENS HLTH PROG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4405
Practice Address - Country:US
Practice Address - Phone:215-955-7800
Practice Address - Fax:215-861-8815
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD423563208000000X, 208D00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101001918Medicaid
NJ0036781Medicaid
MD4053044Medicaid
080718SAJMedicare PIN
MD4053044Medicaid