Provider Demographics
NPI:1295937795
Name:BERDAN, MICHAEL (NP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BERDAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 REVOLUTION DR
Mailing Address - Street 2:SUITE 810
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1446
Mailing Address - Country:US
Mailing Address - Phone:888-897-8947
Mailing Address - Fax:617-526-1909
Practice Address - Street 1:399 REVOLUTION DR
Practice Address - Street 2:SUITE 810
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1446
Practice Address - Country:US
Practice Address - Phone:888-897-8947
Practice Address - Fax:617-526-1909
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA206946363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health