Provider Demographics
NPI:1003857772
Name:BERRY, JOHN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:BERRY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1316
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28503
Mailing Address - Country:US
Mailing Address - Phone:252-522-1626
Mailing Address - Fax:252-522-1486
Practice Address - Street 1:701 DOCTORS DR
Practice Address - Street 2:SUITE A
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1589
Practice Address - Country:US
Practice Address - Phone:252-522-1626
Practice Address - Fax:252-522-1486
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28128208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8915186Medicaid
NC204787AMedicare PIN
NC8915186Medicaid