Provider Demographics
NPI:1548344377
Name:BERMAN, JACOB H (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:H
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4833 EASTWIND RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3144
Mailing Address - Country:US
Mailing Address - Phone:757-467-2143
Mailing Address - Fax:
Practice Address - Street 1:297 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 126
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2911
Practice Address - Country:US
Practice Address - Phone:757-385-0511
Practice Address - Fax:757-497-6201
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010408952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945395Medicaid
VAO85677MOtherPHYSICIAN
VA004945395Medicaid
VAB06193Medicare UPIN