Provider Demographics
NPI:1225051444
Name:BERRY, SCOTT F (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:F
Last Name:BERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 WESTFALL RD
Mailing Address - Street 2:STE 350
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3820
Mailing Address - Country:US
Mailing Address - Phone:585-271-4280
Mailing Address - Fax:585-271-4311
Practice Address - Street 1:156 WEST AVE
Practice Address - Street 2:LAKESIDE MEMORIAL HOSPITAL
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420
Practice Address - Country:US
Practice Address - Phone:585-395-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2237571207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94411Medicare UPIN
RA2557Medicare ID - Type Unspecified