1639168438 NPI number — CHARLES BERUL MD

Table of content: CHARLES BERUL MD (NPI 1639168438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639168438 NPI number — CHARLES BERUL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERUL
Provider First Name:
CHARLES
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639168438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 MICHIGAN AVE, NW
Provider Second Line Business Mailing Address:
CHILDREN'S NATIONAL MEDICAL CENTER
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-476-5710
Provider Business Mailing Address Fax Number:
202-476-5700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 MICHIGAN AVE, NW
Provider Second Line Business Practice Location Address:
CHILDREN'S NATIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-476-5710
Provider Business Practice Location Address Fax Number:
202-476-5700
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0202X , with the licence number:  79476 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 98980501 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: CB27007 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: J30667 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA9204 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 003110939 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2201921 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30007203 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8753601 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7500305 . This is a "UNITED HEALTHCARE MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: B20471601 . This is a "CIGNA MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3183467 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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