Provider Demographics
NPI:1245720630
Name:BERLIN, DILLON L
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:L
Last Name:BERLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 W MYRTLE BAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-3149
Mailing Address - Country:US
Mailing Address - Phone:334-532-2244
Mailing Address - Fax:409-994-6098
Practice Address - Street 1:5034 COBRA RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5932
Practice Address - Country:US
Practice Address - Phone:337-532-2244
Practice Address - Fax:409-994-6098
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies