Basic Information
| Provider Information | |||||||||
| NPI: | 1750515839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERLIN MEDICAL ASSOCIATES-PA | ||||||||
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| OtherOrganizationName: | SOUTHAMPTON MEDICAL ASSOCIATES-MULTI SPECIALTY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 735 DAVISVILLE RD | ||||||||
| Address2: | SUITE 2B | ||||||||
| City: | SOUTHAMPTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189663282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153964227 | ||||||||
| FaxNumber: | 2153544448 | ||||||||
| Practice Location | |||||||||
| Address1: | 735 DAVISVILLE RD | ||||||||
| Address2: | SUITE 2B | ||||||||
| City: | SOUTHAMPTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189663282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153964227 | ||||||||
| FaxNumber: | 2153544448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2009 | ||||||||
| LastUpdateDate: | 05/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | HASSMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8567670077 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | OS003661L | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.