Provider Demographics
NPI:1609853977
Name:BERLOT, ALVIN J (DO)
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:J
Last Name:BERLOT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR4
Mailing Address - Street 2:BOX 4479
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444
Mailing Address - Country:US
Mailing Address - Phone:570-842-0968
Mailing Address - Fax:570-842-0968
Practice Address - Street 1:1089 ROUTE 390
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:PA
Practice Address - Zip Code:18326
Practice Address - Country:US
Practice Address - Phone:570-420-2450
Practice Address - Fax:570-420-2442
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS005689L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS005689LOtherMEDICAL LICENSE
E00773Medicare UPIN