Provider Demographics
NPI:1457316044
Name:BERDINI, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:BERDINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 ASH LN
Mailing Address - Street 2:
Mailing Address - City:RIEGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18077-8001
Mailing Address - Country:US
Mailing Address - Phone:610-749-2118
Mailing Address - Fax:610-749-0936
Practice Address - Street 1:302 ASH LANE
Practice Address - Street 2:
Practice Address - City:RIEGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18077
Practice Address - Country:US
Practice Address - Phone:610-749-2118
Practice Address - Fax:610-749-0936
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044496L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC30368Medicare UPIN
PA639748Medicare PIN