Provider Demographics
NPI:1801855721
Name:BERMAN, JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2660 MAIN STREET
Mailing Address - Street 2:SUITE 216
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5301
Mailing Address - Country:US
Mailing Address - Phone:475-210-3545
Mailing Address - Fax:203-581-6509
Practice Address - Street 1:115 TECHNOLOGY DR UNIT C300
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6347
Practice Address - Country:US
Practice Address - Phone:203-445-7093
Practice Address - Fax:203-638-7981
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT032359207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001323592Medicaid
CTE86475Medicare UPIN
CT060001495Medicare ID - Type Unspecified