Provider Demographics
NPI:1194489443
Name:BERRO, ELIAS JR (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:BERRO
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 E CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-8154
Mailing Address - Country:US
Mailing Address - Phone:610-969-8873
Mailing Address - Fax:
Practice Address - Street 1:2024 E CEDAR ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-8154
Practice Address - Country:US
Practice Address - Phone:610-969-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062179363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant