Provider Demographics
NPI:1023047875
Name:BERENSTEIN, ANNA (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BERENSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 TAMIAMI TRL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8157
Mailing Address - Country:US
Mailing Address - Phone:941-391-5496
Mailing Address - Fax:941-875-9875
Practice Address - Street 1:3390 TAMIAMI TRL
Practice Address - Street 2:SUITE 204
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8157
Practice Address - Country:US
Practice Address - Phone:941-391-5496
Practice Address - Fax:941-875-9875
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1631581207R00000X
FLME127835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY159713OtherELDERPLAN
NY163158A39OtherHEALTHFIRST
NY28756POtherHIP
NYKP359OtherOXFORD
NY0090031OtherGHI COMMERCIAL
NY171911OtherWELLCARE
NY1P0466OtherACS HEALTHNET OF NE
NY1631580199001OtherNEIGHBORHOOD
FLME127835OtherFLORIDA MEDICAL LICENSE
NY040426018134OtherFIDELIS
NYRSX003101OtherAMERICHOICE
NY00932274Medicaid
NY171911OtherWELLCARE
NY0090031OtherGHI COMMERCIAL
NY159713OtherELDERPLAN