Provider Demographics
NPI:1659459196
Name:BERRANG, JOSEPH A (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:BERRANG
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 1:13 SAINT ALBANS CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3622
Mailing Address - Country:US
Mailing Address - Phone:484-422-8647
Mailing Address - Fax:484-422-8648
Practice Address - Street 1:13 SAINT ALBANS CIRCLE
Practice Address - Street 2:SUITE C
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3622
Practice Address - Country:US
Practice Address - Phone:484-422-8647
Practice Address - Fax:484-422-8648
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C518700Medicaid
CA00C518700Medicaid
00C518700Medicare ID - Type Unspecified