Provider Demographics
NPI:1295783546
Name:BERMAN, MARVIN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:DAVID
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARVIN
Other - Middle Name:DAVID
Other - Last Name:BERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:508-235-6349
Practice Address - Fax:508-730-4999
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41964207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110001511AMedicaid
MAE0520402Medicare PIN
MAB10187907OtherCIGNA
MA000000021246OtherBMC HEALTHNET
RI0000025599OtherBLUE CHIP OF RI
RI004236OtherBLUE CHIP
MA110001511AMedicaid
MA30049OtherH PILGRIM
MAE05204OtherBLUE SHIELD OF MA
MAE05204OtherBLUE SHIELD OF MA