Provider Demographics
NPI:1902829864
Name:BERMAN, DAVID LIONEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LIONEL
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2211
Mailing Address - Country:US
Mailing Address - Phone:610-874-2422
Mailing Address - Fax:610-874-2491
Practice Address - Street 1:4000 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2211
Practice Address - Country:US
Practice Address - Phone:610-874-2422
Practice Address - Fax:610-874-2491
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001524L213E00000X
NJZ5MD00138800213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050148Medicaid
PA122804OtherBLUE CROSS BLUE SHIELD
PA050148Medicaid
PA122804HXFMedicare PIN
PA122804OtherBLUE CROSS BLUE SHIELD