Provider Demographics
NPI:1700956349
Name:BERLIN, WILLIAM OLIVER II (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:OLIVER
Last Name:BERLIN
Suffix:II
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 1:4101 BLUE RIDGE PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4166
Mailing Address - Country:US
Mailing Address - Phone:505-314-0748
Mailing Address - Fax:
Practice Address - Street 1:4121 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1102
Practice Address - Country:US
Practice Address - Phone:505-314-0748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM92-183207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00013372Medicaid
NMNM019U17OtherBLUE CROSS BLUE SHIELD
P00209333OtherRAILROAD MEDICARE
F72670Medicare UPIN