Basic Information
| Provider Information | |||||||||
| NPI: | 1609853977 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERLOT | ||||||||
| FirstName: | ALVIN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | RR4 | ||||||||
| Address2: | BOX 4479 | ||||||||
| City: | MOSCOW | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708420968 | ||||||||
| FaxNumber: | 5708420968 | ||||||||
| Practice Location | |||||||||
| Address1: | 1089 ROUTE 390 | ||||||||
| Address2: | |||||||||
| City: | CRESCO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704202450 | ||||||||
| FaxNumber: | 5704202442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS005689L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | OS005689L | 01 | PA | MEDICAL LICENSE | OTHER |