Provider Demographics
NPI:1033328786
Name:BERKSHIRE ALLERGY CARE, P.C.
Entity Type:Organization
Organization Name:BERKSHIRE ALLERGY CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-443-4826
Mailing Address - Street 1:369 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6865
Mailing Address - Country:US
Mailing Address - Phone:413-443-4826
Mailing Address - Fax:413-443-4488
Practice Address - Street 1:369 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6865
Practice Address - Country:US
Practice Address - Phone:413-443-4826
Practice Address - Fax:413-443-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189926207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9785604Medicaid
MA158837OtherTUFTS HEALTH PLAN
MA9785604Medicaid
MAA23727Medicare ID - Type Unspecified