Provider Demographics
NPI:1144209644
Name:BERRY, CATHY J (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:J
Last Name:BERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1149
Mailing Address - Country:US
Mailing Address - Phone:315-422-8105
Mailing Address - Fax:315-471-9903
Practice Address - Street 1:101 PINE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1149
Practice Address - Country:US
Practice Address - Phone:315-422-8105
Practice Address - Fax:315-471-9903
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199230207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0161565449Medicaid
NY0161565449Medicaid
NYB18686Medicare UPIN
NYBA0732Medicare PIN