Provider Demographics
NPI:1881692150
Name:BERMAN, MARK ANDERW (LO, CO)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDERW
Last Name:BERMAN
Suffix:
Gender:M
Credentials:LO, CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11113 BLUE CORAL DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4905
Mailing Address - Country:US
Mailing Address - Phone:561-306-1169
Mailing Address - Fax:561-479-4931
Practice Address - Street 1:11113 BLUE CORAL DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-4905
Practice Address - Country:US
Practice Address - Phone:561-306-1169
Practice Address - Fax:561-479-4931
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT 50222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist