Provider Demographics
NPI:1649453226
Name:BERMING PAN MD INC
Entity type:Organization
Organization Name:BERMING PAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHEN-TSU
Authorized Official - Middle Name:
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-486-4255
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:WANATAH
Mailing Address - State:IN
Mailing Address - Zip Code:46390-0367
Mailing Address - Country:US
Mailing Address - Phone:219-733-2755
Mailing Address - Fax:219-733-2755
Practice Address - Street 1:306 OHIO ST
Practice Address - Street 2:
Practice Address - City:WANATAH
Practice Address - State:IN
Practice Address - Zip Code:46390-0367
Practice Address - Country:US
Practice Address - Phone:219-733-2755
Practice Address - Fax:219-733-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084157OtherBCBS
IN100163680AMedicaid
IND69691Medicare UPIN
IN485580Medicare PIN
IN100163680AMedicaid