Provider Demographics
NPI:1205913910
Name:BERMAN, BENTE H (MD)
Entity type:Individual
Prefix:
First Name:BENTE
Middle Name:H
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29525 CANWOOD ST
Mailing Address - Street 2:SUITE 219
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4233
Mailing Address - Country:US
Mailing Address - Phone:818-865-8133
Mailing Address - Fax:818-865-1223
Practice Address - Street 1:29525 CANWOOD ST
Practice Address - Street 2:SUITE 219
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4233
Practice Address - Country:US
Practice Address - Phone:818-865-8133
Practice Address - Fax:818-865-1223
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG57381207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG57381OtherLICENSE #
CA95-4397431OtherTAX ID #
CAG57381Medicare ID - Type UnspecifiedMEDICARE
CAA53276Medicare UPIN