Provider Demographics
NPI:1235237926
Name:BERRY, JONATHAN JORDAN (MD FACC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JORDAN
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 NORTHLINE AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7616
Mailing Address - Country:US
Mailing Address - Phone:336-273-7900
Mailing Address - Fax:336-273-8147
Practice Address - Street 1:3200 NORTHLINE AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7616
Practice Address - Country:US
Practice Address - Phone:336-273-7900
Practice Address - Fax:336-273-8147
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29892207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11527OtherBCBS NC
NC8911527Medicaid
NC213792FMedicare ID - Type Unspecified
NC11527OtherBCBS NC