Provider Demographics
NPI:1093798415
Name:BERKSHIRE PEDIATRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:BERKSHIRE PEDIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-499-8534
Mailing Address - Street 1:777 NORTH ST STE 305
Mailing Address - Street 2:BERKSHIRE PEDIATRIC ASSOCIATES PC
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4172
Mailing Address - Country:US
Mailing Address - Phone:413-499-8531
Mailing Address - Fax:413-499-8560
Practice Address - Street 1:777 NORTH ST STE 305
Practice Address - Street 2:BERKSHIRE PEDIATRIC ASSOCIATES PC
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4172
Practice Address - Country:US
Practice Address - Phone:413-499-8531
Practice Address - Fax:413-499-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17595OtherBLUE CROSS GRP
MA9701290Medicaid
MAM21475Medicare PIN