Provider Demographics
NPI:1144289877
Name:BERKENBLIT, SCOTT IRA (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:IRA
Last Name:BERKENBLIT
Suffix:
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 1:4313 ROLAND SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2756
Mailing Address - Country:US
Mailing Address - Phone:410-467-5047
Mailing Address - Fax:
Practice Address - Street 1:14201 PARK CENTER DR STE 410
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5251
Practice Address - Country:US
Practice Address - Phone:301-498-0383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054384174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H33291Medicare UPIN
MD010812R26Medicare ID - Type Unspecified