Provider Demographics
NPI:1700882529
Name:BERAHA, NATHAN B (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:B
Last Name:BERAHA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 COMMERCE ST
Mailing Address - Street 2:PEDIATRICS
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1168
Mailing Address - Country:US
Mailing Address - Phone:401-793-8484
Mailing Address - Fax:401-793-8481
Practice Address - Street 1:1 COMMERCE ST
Practice Address - Street 2:PEDIATRICS
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865
Practice Address - Country:US
Practice Address - Phone:401-793-8484
Practice Address - Fax:401-793-8481
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2020-12-07
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Provider Licenses
StateLicense IDTaxonomies
RIMD066562080P0202X, 2080A0000X
WI40994-0202080A0000X
MA2042752080A0000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2005484Medicaid
RI7002149Medicaid
RI7002149Medicaid
MA2005484Medicaid