Provider Demographics
NPI:1184609653
Name:BERMAN, BRAD DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:DAVID
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRAD
Other - Middle Name:DAVID
Other - Last Name:BERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3021 CITRUS CIR STE 240
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2691
Mailing Address - Country:US
Mailing Address - Phone:925-279-3480
Mailing Address - Fax:925-279-3485
Practice Address - Street 1:3021 CITRUS CIR STE 240
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2691
Practice Address - Country:US
Practice Address - Phone:925-279-3480
Practice Address - Fax:925-279-3485
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG574242080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F16597Medicare UPIN