Provider Demographics
NPI:1144081670
Name:BERMAN, MICHELLE KRUTAN (LDN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KRUTAN
Last Name:BERMAN
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KRUTAN
Other - Last Name:BERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LDN
Mailing Address - Street 1:7610 CARROLL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6321
Mailing Address - Country:US
Mailing Address - Phone:301-891-6141
Mailing Address - Fax:301-891-6841
Practice Address - Street 1:7610 CARROLL AVE STE 400
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6321
Practice Address - Country:US
Practice Address - Phone:301-891-6141
Practice Address - Fax:301-891-6841
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2951133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty