Provider Demographics
NPI:1104044379
Name:JOSEPH BERK MD PA
Entity Type:Organization
Organization Name:JOSEPH BERK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-933-6423
Mailing Address - Street 1:9199 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 207A
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4520
Mailing Address - Country:US
Mailing Address - Phone:410-654-4525
Mailing Address - Fax:
Practice Address - Street 1:9199 REISTERSTOWN RD
Practice Address - Street 2:SUITE 207A
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4520
Practice Address - Country:US
Practice Address - Phone:410-654-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD094391600Medicaid